COVID-19: breaking down a global health crisis

Analysis of risk factors and construction of a prediction model for posttraumatic stress disorder among Chinese college students during the COVID-19 pandemic

BACKGROUND

To explore the risk factors of post-traumatic stress disorder (PTSD) among Chinese college students during the COVID-19 pandemic and the construction and validation of risk prediction models.

METHODS

A total of 10,705 university students were selected for the study. The questionnaire included the Generalized Anxiety Disorder 7 (GAD-7), Patient Health Questionnaire 9 (PHQ-9), PTSD Checklist for DSM-5 (PCL-5), and self-designed questionnaire. These assessments were conducted to facilitate the survey, construct the predictive model and validate the model's validity.

RESULTS

Sex, left-behind experience, poverty status, anxiety score, and depression score were identified as independent risk factors influencing psychological trauma among Chinese college students during the COVID-19 pandemic, while COVID-19 infection emerged as a protective factor against psychological trauma. A column chart was constructed to visualize the six independent risk factors derived from logistic regression analysis. The Hosmer-Lemeshow test results (χ2 = 13.021, P = 0.111) indicated that the risk prediction model fitted well. The receiver operating characteristic (ROC) curve showed an area under the curve (AUC) of 0.864 in the model group and 0.855 in the validation group. The calibration curves of the model closely resembled the ideal curve. Decision curve analysis (DCA) revealed that the model provided net benefit and demonstrated good clinical utility.

LIMITATIONS

The validation of the model is currently restricted to internal assessments. However, further confirmation through larger sample sizes, multicenter investigations, and prospective studies is necessary.

CONCLUSIONS

The model effectively predicted PTSD risk among Chinese college students during the COVID-19 pandemic, indicating strong clinical applicability.

Bebtelovimab-bound SARS-CoV-2 RBD mutants: resistance profiling and validation with escape mutations, clinical results, and viral genome sequences

The dynamic evolution of SARS-CoV-2 variants necessitates ongoing advancements in therapeutic strategies. Despite the promise of monoclonal antibody (mAb) therapies like bebtelovimab, concerns persist regarding resistance mutations, particularly single-to-multipoint mutations in the receptor-binding domain (RBD). Our study addresses this by employing interface-guided computational protein design to predict potential bebtelovimab-resistance mutations. Through extensive physicochemical analysis, mutational preferences, precision-recall metrics, protein-protein docking, and energetic analyses, combined with all-atom, and coarse-grained molecular dynamics (MD) simulations, we elucidated the structural-dynamics-binding features of the bebtelovimab-RBD complexes. Identification of susceptible RBD residues under positive selection pressure, coupled with validation against bebtelovimab-escape mutations, clinically reported resistance mutations, and viral genomic sequences enhances the translational significance of our findings and contributes to a better understanding of the resistance mechanisms of SARS-CoV-2.

A Cross-Border Biorisk Toolkit for Healthcare Professionals

The COVID-19 pandemic posed significant challenges to public health, exposing first responders to high biosafety risks during medical assistance and containment efforts. The PANDEM-2 study aimed to address these critical biosafety issues by emphasising the importance of frequently updated, harmonised guidelines. This study reviewed scientific publications, lessons learned, and real-world experiences from the COVID-19 pandemic to identify biorisk gaps in three critical areas: (i) patient transportation and management, (ii) sample handling and testing, and (iii) data management and communication by laboratory staff. At the onset of the pandemic, first responders faced several challenges, including the rapid expansion of emergency medical services, conversion of non-medical structures, increased internal and cross-border transport of infected patients, frequent changes in biosafety protocols, and a shortage of personal protective equipment. In response, this study developed a versatile and easily adaptable toolkit, including biosafety guidance and recommendations linked to updated national and international online repositories. It establishes the groundwork for a minimum standard that can be tailored to various pandemic response scenarios, using monkeypox as a fictive test case. The toolkit enables rapid access to updated information via QR codes and mobile devices, improving biorisk response by providing an adaptable and standardised approach for caregivers involved in national and cross-border responses.

Potential SARS-CoV-2 Mpro steroid inhibitors from Aphanamixis polystachya (Wall.) R. N. Parker

Herein, six previously undescribed steroids (1-6), were isolated from leaves and twigs of Aphanamixis polystachya (Wall.) R. N. Parker (Meliaceae). Their structures were elucidated by comprehensive spectroscopic analysis, including HRESIMS, 1D and 2D NMR, UV, and IR. Antiviral activity of these compounds were evaluated. Compounds 1-6 showed varying degrees of inhibitory activity against the severe acute respiratory syndrome coronavirus 2 main protease (SARS-CoV-2 Mpro) at 200 μM.

A brief overview of SARS-CoV-2 infection and its management strategies: a recent update

The COVID-19 pandemic has become a global health crisis, inflicting substantial morbidity and mortality worldwide. A diverse range of symptoms, including fever, cough, dyspnea, and fatigue, characterizes COVID-19. A cytokine surge can exacerbate the disease's severity. This phenomenon involves an increased immune response, marked by the excessive release of inflammatory cytokines like IL-6, IL-8, TNF-α, and IFNγ, leading to tissue damage and organ dysfunction. Efforts to reduce the cytokine surge and its associated complications have garnered significant attention. Standardized management protocols have incorporated treatment strategies, with corticosteroids, chloroquine, and intravenous immunoglobulin taking the forefront. The recent therapeutic intervention has also assisted in novel strategies like repurposing existing medications and the utilization of in vitro drug screening methods to choose effective molecules against viral infections. Beyond acute management, the significance of comprehensive post-COVID-19 management strategies, like remedial measures including nutritional guidance, multidisciplinary care, and follow-up, has become increasingly evident. As the understanding of COVID-19 pathogenesis deepens, it is becoming increasingly evident that a tailored approach to therapy is imperative. This review focuses on effective treatment measures aimed at mitigating COVID-19 severity and highlights the significance of comprehensive COVID-19 management strategies that show promise in the battle against COVID-19.

Prediction of COVID-19 Hospitalization and Mortality Using Artificial Intelligence

BACKGROUND

COVID-19 has had a substantial influence on healthcare systems, requiring early prognosis for innovative therapies and optimal results, especially in individuals with comorbidities. AI systems have been used by healthcare practitioners for investigating, anticipating, and predicting diseases, through means including medication development, clinical trial analysis, and pandemic forecasting. This study proposes the use of AI to predict disease severity in terms of hospital mortality among COVID-19 patients.

METHODS

A cross-sectional study was conducted at King Abdulaziz University, Saudi Arabia. Data were cleaned by encoding categorical variables and replacing missing quantitative values with their mean. The outcome variable, hospital mortality, was labeled as death = 0 or survival = 1, with all baseline investigations, clinical symptoms, and laboratory findings used as predictors. Decision trees, SVM, and random forest algorithms were employed. The training process included splitting the data set into training and testing sets, performing 5-fold cross-validation to tune hyperparameters, and evaluating performance on the test set using accuracy.

RESULTS

The study assessed the predictive accuracy of outcomes and mortality for COVID-19 patients based on factors such as CRP, LDH, Ferritin, ALP, Bilirubin, D-Dimers, and hospital stay (p-value ≤ 0.05). The analysis revealed that hospital stay, D-Dimers, ALP, Bilirubin, LDH, CRP, and Ferritin significantly influenced hospital mortality (p ≤ 0.0001). The results demonstrated high predictive accuracy, with decision trees achieving 76%, random forest 80%, and support vector machines (SVMs) 82%.

CONCLUSIONS

Artificial intelligence is a tool crucial for identifying early coronavirus infections and monitoring patient conditions. It improves treatment consistency and decision-making via the development of algorithms.

Interrupted time series analysis of the impact of the COVID-19 pandemic and compulsory social health insurance system on fertility rates: a study of live births in Kazakhstan, 2019-2023

Introduction

The COVID-19 pandemic triggered global health crises, affecting population health directly through infections and fatalities, and indirectly by increasing the burden of chronic diseases due to disrupted healthcare access and altered lifestyle behaviors. Amidst these challenges, concerns regarding reproductive health and fertility rates have emerged, necessitating an understanding of their implications for policymaking and healthcare planning. Furthermore, Kazakhstan's healthcare landscape underwent significant changes with the reintroduction of compulsory social health insurance system in January 2020, coinciding with the onset of the COVID-19 pandemic. This study aims to assess the impact of the COVID-19 pandemic and compulsory social health insurance system on fertility rates in Kazakhstan by examining live birth data from 2019 to 2024.

Methods

Using Interrupted Time Series analysis, we evaluated the effect of the COVID-19 lockdown announcement and compulsory social health insurance system implementation on monthly birth rates, adjusted for the number of women of reproductive age from January 2019 to December 2023.

Results

In the final model, the coefficients were as follows: the effect of the COVID-19 lockdown was estimated at 469 (SE = 2600, p = 0.8576); the centering variable was estimated at 318 (SE = 222, p = 0.1573), suggesting no significant trend in monthly birth rates over time; the insurance effect was estimated at 7,050 (SE = 2,530, p < 0.01); and the effect of the number of women of reproductive age was estimated at -0.204 (SE = 0.0831, p = 0.01).

Discussion

The implementation of the compulsory social health insurance system, rather than the announcement of the COVID-19 lockdown, has had a significant positive impact on live birth rates in Kazakhstan. However, despite governmental efforts, live birth rates are declining, potentially due to unaddressed health needs of fertile women and economic challenges. Urgent policy-level actions are needed to address gaps in healthcare services and promote reproductive health.

Novel Insights into the Antimicrobial and Antibiofilm Activity of Pyrroloquinoline Quinone (PQQ); In Vitro, In Silico, and Shotgun Proteomic Studies

Microbial infections pose a significant global health threat, affecting millions of individuals and leading to substantial mortality rates. The increasing resistance of microorganisms to conventional treatments requires the development of novel antimicrobial agents. Pyrroloquinoline quinone (PQQ), a natural medicinal drug involved in various cellular processes, holds promise as a potential antimicrobial agent. In the present study, our aim was, for the first time, to explore the antimicrobial activity of PQQ against 29 pathogenic microbes, including 13 fungal strains, 8 Gram-positive bacteria, and 8 Gram-negative bacteria. Our findings revealed potent antifungal properties of PQQ, particularly against Syncephalastrum racemosum, Talaromyces marneffei, Candida lipolytica, and Trichophyton rubrum. The MIC values varied between fungal strains, and T. marneffei exhibited a lower MIC, indicating a greater susceptibility to PQQ. In addition, PQQ exhibited notable antibacterial activity against Gram-positive and -negative bacteria, with a prominent inhibition observed against Staphylococcus epidermidis, Proteus vulgaris, and MRSA strains. Remarkably, PQQ demonstrated considerable biofilm inhibition against the MRSA, S. epidermidis, and P. vulgaris strains. Transmission electron microscopy (TEM) studies revealed that PQQ caused structural damage and disrupted cell metabolism in bacterial cells, leading to aberrant morphology, compromised cell membrane integrity, and leakage of cytoplasmic contents. These findings were further affirmed by shotgun proteomic analysis, which revealed that PQQ targets several important cellular processes in bacteria, including membrane proteins, ATP metabolic processes, DNA repair processes, metal-binding proteins, and stress response. Finally, detailed molecular modeling investigations indicated that PQQ exhibits a substantial binding affinity score for key microbial targets, including the mannoprotein Mp1P, the transcriptional regulator TcaR, and the endonuclease PvuRTs1I. Taken together, our study underscores the effectiveness of PQQ as a broad-spectrum antimicrobial agent capable of combating pathogenic fungi and bacteria, while also inhibiting biofilm formation and targeting several critical biological processes, making it a promising therapeutic option for biofilm-related infections.

Has Covid-19 left an imprint on our levels of life satisfaction? Empirical evidence from the Netherlands

Many papers have investigated the effects of Covid-19 on people's well-being shortly after the epidemic's outbreak. In this article, we use the joint World Values Survey (WVS) and European Value Study (EVS) 2017-2022 dataset and employ OLS (Ordinary Least Squares) regressions and Coarsened Exact Matching, to evaluate the possible existence of a persistent effect on life satisfaction, two years after the start of the pandemic. We have chosen to focus on the Netherlands -a country which appears among the happiest in the world and for which we have available data- to assess the impact of the Covid-19 pandemic at this later stage. The results of our analysis seem to indicate that the pandemic has contributed to reducing the levels of life satisfaction significantly, particularly among the younger generation. These findings show that specific intervention programmes should be created focusing on different age groups.

Evaluation of microstructural brain changes in post-coronavirus disease 2019 (COVID-19) patients with neurological symptoms: a cross-sectional study

Background

Changes in both the vascular system and brain tissues can occur after a prior episode of coronavirus disease 2019 (COVID-19), detectable through modifications in diffusion parameters using magnetic resonance imaging (MRI) techniques. These changes in diffusion parameters may be particularly prominent in highly organized structures such as the corpus callosum (CC), including its major components, which have not been adequately studied following COVID-19 infection. Therefore, the study aimed to evaluate microstructural changes in whole-brain (WB) diffusion, with a specific focus on the CC.

Methods

A total of 101 probands (age range from 18 to 69 years) participated in this retrospective study, consisting of 55 volunteers and 46 post-COVID-19 patients experiencing neurological symptoms. The participants were recruited from April 2022 to September 2023 at the Institute for Clinical and Experimental Medicine in Prague, Czech Republic. All participants underwent MRI examinations on a 3T MR scanner with a diffusion protocol, complemented by additional MRI techniques. Two volunteers and five patients were excluded from the study due to motion artefacts, severe hypoperfusion or the presence of lesions. Participants were selected by a neurologist based on clinical examination and a serological test for COVID-19 antibodies. They were then divided into three groups: a control group of healthy volunteers (n=28), an asymptomatic group (n=25) with a history of infection but no symptoms, and a symptomatic group (n=41) with a history of COVID-19 and neurological symptoms. Symptomatic patients did not exhibit neurological symptoms before contracting COVID-19. Diffusion data underwent eddy current and susceptibility distortion corrections, and fiber tracking was performed using default parameters in DSI studio. Subsequently, various diffusion metrics, were computed within the reconstructed tracts of the WB and CC. To assess the impact of COVID-19 and its associated symptoms on diffusion indices within the white matter of the WB and CC regions, while considering age, we employed a statistical analysis using a linear mixed-effects model within the R framework.

Results

Statistical analysis revealed a significant difference in mean diffusivity (MD) between the symptomatic and control groups in the forceps minor (P=0.001) and CC body (P=0.003). In addition to changes in diffusion, alterations in brain perfusion were observed in two post-COVID-19 patients who experienced a severe course. Furthermore, hyperintense lesions were identified in subcortical and deep white matter areas in the vast majority of symptomatic patients.

Conclusions

The main finding of our study was that post-COVID-19 patients exhibit increased MD in the forceps minor and body of the CC. This finding suggests a potential association between microstructural brain changes in post-COVID-19 patients and reported neurological symptoms, with significant implications for research and clinical applications.

Targeted metabolomics identifies accurate CSF metabolite biomarkers for the differentiation between COVID-19 with neurological involvement and CNS infections with neurotropic viral pathogens

BACKGROUND

COVID-19 is primarily considered a respiratory tract infection, but it can also affect the central nervous system (CNS), which can result in long-term sequelae. In contrast to CNS infections by classic neurotropic viruses, SARS-CoV-2 is usually not detected in cerebrospinal fluid (CSF) from patients with COVID-19 with neurological involvement (neuro-COVID), suggesting fundamental differences in pathogenesis.

METHODS

To assess differences in CNS metabolism in neuro-COVID compared to CNS infections with classic neurotropic viruses, we applied a targeted metabolomic analysis of 630 metabolites to CSF from patients with (i) COVID-19 with neurological involvement [n = 16, comprising acute (n = 13) and post-COVID-19 (n = 3)], (ii) viral meningitis, encephalitis, or myelitis (n = 10) due to herpes simplex virus (n = 2), varicella zoster virus (n = 6), enterovirus (n = 1) and tick-borne encephalitis virus (n = 1), and (iii) aseptic neuroinflammation (meningitis, encephalitis, or myelitis) of unknown etiology (n = 21) as additional disease controls.

RESULTS

Standard CSF parameters indicated absent or low neuroinflammation in neuro-COVID. Indeed, CSF cell count was low in neuro-COVID (median 1 cell/µL, range 0-12) and discriminated it accurately from viral CNS infections (AUC = 0.99) and aseptic neuroinflammation (AUC = 0.98). 32 CSF metabolites passed quality assessment and were included in the analysis. Concentrations of differentially abundant (fold change ≥|1.5|, FDR ≤ 0.05) metabolites were both higher (9 and 5 metabolites) and lower (2 metabolites) in neuro-COVID than in the other two groups. Concentrations of citrulline, ceramide (d18:1/18:0), and methionine were most significantly elevated in neuro-COVID. Remarkably, triglyceride TG(20:1_32:3) was much lower (mean fold change = 0.09 and 0.11) in neuro-COVID than in all viral CNS infections and most aseptic neuroinflammation samples, identifying it as highly accurate biomarker with AUC = 1 and 0.93, respectively. Across all samples, TG(20:1_32:3) concentration correlated only moderately with CSF cell count (ρ = 0.65), protein concentration (ρ = 0.64), and Q-albumin (ρ = 0.48), suggesting that its low levels in neuro-COVID CSF are only partially explained by less pronounced neuroinflammation.

CONCLUSIONS

The results suggest that CNS metabolite responses in neuro-COVID differ fundamentally from viral CNS infections and aseptic neuroinflammation and may be used to discover accurate diagnostic biomarkers in CSF and to gain insights into differences in pathophysiology between neuro-COVID, viral CNS infections and aseptic neuroinflammation.

Dysphonia and other voice alterations associated with COVID-19: Systematic review

Among the symptoms presented by patients with SARS-Cov-2 infection, we can find various otorhinolaryngological alterations. Dysphonia appears in up to 79% of infected patients during the acute phase. Dysphonia can also occur as a sequelae, often underestimated, possibly due to its appearance along with other symptoms, also in patients after prolonged intubation or tracheostomy. We present a systematic review of the literature with a bibliographic search in PubMed, Cochrane and Google Scholar, with MESH terms including studies in English and Spanish. The results of the studies found and the vocal manifestations in patients during COVID-19 disease and the consequences produced are analysed. Dysphonia is an acute manifestation of COVID-19 with alterations in aerodynamic and acoustic analysis and in fibrolaryngoscopy. Post-COVID dysphonia can be a persistent symptom that is often underestimated, requiring multidisciplinary management and speech therapy intervention. Laryngeal sequelae are common in post-intubation or post-tracheostomy patients and are related to intubation time, tube number, pronation and respiratory sequelae.

Potential association between COVID-19 infections and the declining incidence of lung cancers

BACKGROUND

The COVID-19 pandemic has significantly impacted global health and prompted studies on its effects across various diseases. Recent data suggest a potential correlation between COVID-19 and a decrease in lung cancer incidence. This study examines the association between COVID-19 infection and changes in lung cancer cases.

MATERIAL AND METHODS

We conducted a retrospective analysis of medical records from Clinic Lüdenscheid, Germany, from January 1, 2018, to December 31, 2021, comparing lung cancer cases before and during the pandemic. Demographic characteristics and cancer stages were also assessed.

RESULTS

We evaluated 523 patients; 269 pre-COVID and 254 during COVID. While the overall number of cases declined, a significant increase in advanced stage cancers was noted during COVID (P = 0.04). The adjusted incidence rates showed a nuanced decrease from approximately 33 cases per 100,000 pre-COVID to 31 during COVID.

CONCLUSION

This retrospective study suggests a modest decline in lung cancer incidence and an increase in advanced stages during COVID. Further comparisons with national data indicate a similar trend across Germany, with a decrease of about 3 % in lung cancer diagnoses post-2020, highlighting potential pandemic impacts on cancer detection.

Lung ultrasound is associated with distinct clinical phenotypes in COVID-19 ARDS: A retrospective observational study

BACKGROUND

ARDS is a heterogeneous syndrome with distinct clinical phenotypes. Here we investigate whether the presence or absence of large pulmonary ultrasonographic consolidations can categorize COVID-19 ARDS patients requiring mechanical ventilation into distinct clinical phenotypes.

METHODS

This is a retrospective study performed in a tertiary-level intensive care unit in Israel between April and September 2020. Data collected included lung ultrasound (LUS) findings, respiratory parameters, and treatment interventions. The primary outcome was a composite of three ARDS interventions: prone positioning, high PEEP, or a high dose of inhaled nitric oxide.

RESULTS

A total of 128 LUS scans were conducted among 23 patients. The mean age was 65 and about two-thirds were males. 81 scans identified large consolidation and were classified as "C-type", and 47 scans showed multiple B-lines with no or small consolidation and were classified as "B-type". The presence of a "C-type" study had 2.5 times increased chance of receiving the composite primary outcome of advanced ARDS interventions despite similar SOFA scores, Pao2/FiO2 ratio, and markers of disease severity (OR = 2.49, %95CI 1.40-4.44).

CONCLUSION

The presence of a "C-type" profile with LUS consolidation potentially represents a distinct COVID-19 ARDS subphenotype that is more likely to require aggressive ARDS interventions. Further studies are required to validate this phenotype in a larger cohort and determine causality, diagnostic, and treatment responses.

Children aged 0-14 years had a far lower mortality risk during the entire COVID-19 pandemic in four major industrial countries: an observational study

The purpose of this study is to describe the morbidity and mortality of children during the entire COVID-19 pandemic. Age-disaggregated data of 108,003,741 cases and 560,426 deaths were collected from Canada, France, Germany, and Italy. The number of cases and deaths per million people per week, as well as case fatality rates (CFRs), were calculated for patients aged 0-14 and ≥ 15 years. During the first pandemic period in the four countries, starting from weeks 4 to 11 (in 2020) and ending at week 22 (in 2021), the number of deaths per million people per week and the CFRs in the ≥ 15 years age group were 500 to 2513 and 442 to 1662 times greater, respectively, than those in the 0-14 years age group. The number of deaths per million people per week was significantly lower in the first pandemic period than in the second pandemic period, which started at week 23 (2021) and ended from week 22 to week 25 (2023). During the second pandemic period in the four countries, the disparities between the ≥ 15 years and 0-14 years age groups decreased, and the number of deaths per million people per week in the ≥ 15 years age group was 76 to 180 times greater than it in the 0-14 years age group.

CONCLUSION

 Children aged 0-14 years had a far lower mortality risk during the entire COVID-19 pandemic, and the impact of viral variants and/or vaccination on the mortality rate is difficult to distinguish.

WHAT IS KNOWN

• Although extensive studies have focused on COVID-19-induced mortality, most of them are provisional reports performed during the unfolding of the pandemic and provide imprecise conclusion.

WHAT IS NEW

• We described the morbidity and mortality for children aged 0-14 years using complete survey data recorded during the entire COVID-19 pandemic. • The number of deaths per million people per week was far lower in children aged 0-14 years, while the number of deaths per million people per week in children aged 0-14 years was significantly higher in the second period which starting from week 23 (2021) and ending at week 22 to 25 (2023) than in the first period which starting from week 1 to 11 (2020) and ending at week 22 (2021).

Knowledge as a Predictor for Preparedness in Managing COVID-19 Among General Practitioners in Malaysia

Introduction The COVID-19 pandemic has changed the working environment for general practitioners (GPs). GPs had to adapt quickly when care mitigation for mild COVID-19 in the community began. We assessed Malaysian GPs' knowledge and preparedness to manage COVID-19. Method A cross-sectional online survey was conducted between May and October 2022 among the GPs. Emails were sent to GPs affiliated with the main GP organizations in Malaysia, such as the Academy of Family Physicians of Malaysia (AFPM). Additionally, participation was sought through social media groups, including the Association of Malaysian Islamic Doctors, the Federation of Private Medical Practitioners' Associations Malaysia, and the Primary Care Network. Data was collected using a self-administered questionnaire on items related to knowledge and preparedness to manage COVID-19. The content was validated by six experts. Multiple logistic regression was used to determine the predictors for preparedness. Results A total of 178 GPs participated in this study. The mean age of the GPs was 41.8 (SD 12.37) years, 54.5% were males, 47.8% had a postgraduate qualification, and 68% had up to 10 years of general practice experience. Their practices are commonly solo (55.1%), located within an urban area (56.2%) and 47.2% operate 7 days a week. A majority of GPs (n = 124, 69.7%) had a good level of knowledge of COVID-19. In contrast, about a third (n = 60, 33.7%) had a good level of preparedness to manage COVID-19. GPs with a good level of knowledge of COVID-19 had 1.96 times the odds of having a good level of preparedness as compared to GPs with lower knowledge (OR = 2.11 (95% CI: 1.06, 4.18, p = 0.03)). Conclusion A good level of knowledge is a predictor for preparedness to manage COVID-19. Relevant and targeted measures to enhance knowledge for better preparedness among the GPs to respond to future pandemics are needed.

Advances in Nucleic Acid Assays for Infectious Disease: The Role of Microfluidic Technology

Within the fields of infectious disease diagnostics, microfluidic-based integrated technology systems have become a vital technology in enhancing the rapidity, accuracy, and portability of pathogen detection. These systems synergize microfluidic techniques with advanced molecular biology methods, including reverse transcription polymerase chain reaction (RT-PCR), loop-mediated isothermal amplification (LAMP), and clustered regularly interspaced short palindromic repeats (CRISPR), have been successfully used to identify a diverse array of pathogens, including COVID-19, Ebola, Zika, and dengue fever. This review outlines the advances in pathogen detection, attributing them to the integration of microfluidic technology with traditional molecular biology methods and smartphone- and paper-based diagnostic assays. The cutting-edge diagnostic technologies are of critical importance for disease prevention and epidemic surveillance. Looking ahead, research is expected to focus on increasing detection sensitivity, streamlining testing processes, reducing costs, and enhancing the capability for remote data sharing. These improvements aim to achieve broader coverage and quicker response mechanisms, thereby constructing a more robust defense for global public health security.

Outcomes of telemedicine care during the COVID-19 pandemic: Experience from an intervention program designed for vulnerable population in Brazil

PURPOSE

Telehealth plays an important role on the combat of COVID-19. In this context, the SAS Brasil telemedicine program became a viable option in Brazil, where the population faced challenging access to healthcare services during the pandemics. In this study, we describe the sociodemographic profile, reasons for enrollment, outcomes of consultation, and satisfaction of participants who received telemedicine consultations through the SAS program.

METHODS

A retrospective cross-sectional study was conducted with data from the SAS Telemedicine program including consultations performed from July 15, 2020, to April 15, 2021. The study describes the SAS Brasil experience and data collected in the period. Patients' satisfaction perception was evaluated through the Net Promoter Score (NPS).

RESULTS

A total of 6490 participants were evaluated, 69.5% of them were female and 40.8% with age from 21 to 40 years. In the period, 22,664 teleconsultations were performed, mainly due to Mental health (40.4%), Respiratory (35.8%), and Nutritional (4.5%) disorders. Out of the 6312 patients with a defined outcome along the period, 96.0% were discharged and 4.0% were referred to presential care. The calculated NPS was + 95.77 and most patients answered that they would use the service again if needed (99.21%) and had their issue resolved (89.76%).

CONCLUSION

During the period of the COVID-19 pandemic, telehealth has been consolidated as a tool that offers access to specialized healthcare with wide acceptance by users and can be implemented in populations in vulnerability situations.

Longitudinal Analysis of Humoral and Cellular Immune Response up to 6 Months after SARS-CoV-2 BA.5/BF.7/XBB Breakthrough Infection and BA.5/BF.7-XBB Reinfection

The rapid mutation of SARS-CoV-2 has led to multiple rounds of large-scale breakthrough infection and reinfection worldwide. However, the dynamic changes of humoral and cellular immunity responses to several subvariants after infection remain unclear. In our study, a 6-month longitudinal immune response evaluation was conducted on 118 sera and 50 PBMC samples from 49 healthy individuals who experienced BA.5/BF.7/XBB breakthrough infection or BA.5/BF.7-XBB reinfection. By studying antibody response, memory B cell, and IFN-γ secreting CD4+/CD8+ T cell response to several SARS-CoV-2 variants, we observed that each component of immune response exhibited distinct kinetics. Either BA.5/BF.7/XBB breakthrough infection or BA.5/BF.7-XBB reinfection induces relatively high level of binding and neutralizing antibody titers against Omicron subvariants at an early time point, which rapidly decreases over time. Most of the individuals at 6 months post-breakthrough infection completely lost their neutralizing activities against BQ.1.1, CH.1.1, BA.2.86, JN.1 and XBB subvariants. Individuals with BA.5/BF.7-XBB reinfection exhibit immune imprinting shifting and recall pre-existing BA.5/BF.7 neutralization antibodies. In the BA.5 breakthrough infection group, the frequency of BA.5 and XBB.1.16-RBD specific memory B cells, resting memory B cells, and intermediate memory B cells gradually increased over time. On the other hand, the frequency of IFN-γ secreting CD4+/CD8+ T cells induced by WT/BA.5/XBB.1.16 spike trimer remains stable over time. Overall, our research indicates that individuals with breakthrough infection have rapidly declining antibody levels but have a relatively stable cellular immunity that can provide some degree of protection from future exposure to new antigens.

Impact of the COVID-19 outbreak and interventions on hand, foot and mouth disease in Zhengzhou, China, 2014-2022: a retrospective study

BACKGROUND

Since December 2019, COVID-19 has spread rapidly around the world, and studies have shown that measures to prevent COVID-19 can largely reduce the spread of other infectious diseases. This study explored the impact of the COVID-19 outbreak and interventions on the incidence of HFMD.

METHODS

We gathered data on the prevalence of HFMD from the Children's Hospital Affiliated to Zhengzhou University. An autoregressive integrated moving average model was constructed using HFMD incidence data from 2014 to 2019, the number of cases predicted from 2020 to 2022 was predicted, and the predicted values were compared with the actual measurements.

RESULTS

From January 2014 to October 2022, the Children's Hospital of Zhengzhou University admitted 103,995 children with HFMD. The average number of cases of HFMD from 2020 to 2022 was 4,946, a significant decrease from 14,859 cases from 2014 to 2019. We confirmed the best ARIMA (2,0,0) (1,1,0)12 model. From 2020 to 2022, the yearly number of cases decreased by 46.58%, 75.54%, and 66.16%, respectively, compared with the forecasted incidence. Trends in incidence across sexes and ages displayed patterns similar to those overall.

CONCLUSIONS

The COVID-19 outbreak and interventions reduced the incidence of HFMD compared to that before the outbreak. Strengthening public health interventions remains a priority in the prevention of HFMD.

Psychological Impact of the COVID-19 Pandemic on Canadian Surgical Residents: A Province-Wide Study

OBJECTIVES

The objective of this study was to evaluate the psychological impact of the COVID-19 pandemic on surgical residents.

DESIGN

An online survey was distributed evaluating multiple domains: demographics, health and socioeconomic factors, clinical experience, educational experience, and psychological outcomes. The Mayo Clinic Resident Well-Being Index (RWBI) was used as a validated measure of resident mental health.

SETTING AND PARTICIPANTS

Surgical residents from University of British Columbia's surgical residency programs.

RESULTS

A total of 31/86 surgical residents responded to the survey. Of which, 57% and 46% reported feeling burned out or depressed, respectively. Residents who were concerned about personal protective equipment supply and who lived with family members with comorbidities had a higher risk of depression (p = 0.03, p = 0.04). The median Mayo Clinic Resident Well-Being Index was 2.5, higher than the median of 2 observed in the United States national survey of residents.

CONCLUSIONS

The pandemic had a considerable negative impact on the psychological well-being of surgical residents.

Knowledge, attitudes and practices towards COVID-19 among healthcare workers: A cross-sectional survey from Kiambu County, Kenya

BACKGROUND

The knowledge possessed by healthcare workers (HCWs), along with their attitudes and practices play a vital role in effectively managing a pandemic. This is crucial considering that HCWs are exposed to great risk at the forefront of such crises. We aimed to describe the knowledge, attitude, and practices (KAP) of HCWs during the COVID-19 pandemic in Kiambu county, Kenya.

METHODS

A cross-sectional study using a structured questionnaire was conducted from 11th March 2021 to 12th August 2021. Bloom's cutoff points were used to determine KAP scores (>80%: good, 60-79%: medium and <60% poor). Multivariable ordinal logistic regression analyses were conducted, calculating adjusted odds ratios (AOR) at a 95% confidence interval. Spearman's rank correlations were used to examine the relationship between KAP scores.

RESULTS

438 HCWs participated in the study, majority of whom were female (64.5%), had obtained a diploma (59.6%) and were informed through government websites (78.6%). 43.0% had good knowledge, 17.5% good attitudes, and 68.4% good practice. 23.0% had medium knowledge, 35.6% medium attitude, 15.7% medium practice, while 34.0% had poor knowledge, 46.9% poor attitude and 15.9% poor practice. Only 68.9% of the caregivers correctly recognized the county's COVID-19 isolation centre and only 7.9% chose the two correct documents for the entry of data for a suspected COVID-19 case. Furthermore, the general attitude towards their own personal safety and their training regarding PPEs (17.8% and 23.8% strongly agreed with the contrary) were less compelling. There was a significant positive association between obtaining information from international government sites [AOR: 1.382 (1.058-1.807); p = 0.0178)] and good knowledge. Referring to local government sites for information regarding COVID-19 produced better attitudes [AOR: 1.710 (1.194-2.465); p = 0.0036] and produced almost twice the odds of having better practice [AOR: 1.800 (1.181-2.681); p = 0.0048]. There was a significant correlation between knowledge and practice (r = -0.330, p = 2.766×10-11), and knowledge and attitude (r = -0.154, p = 6.538×10-3).

CONCLUSION

This study emphasizes the substantial impact that governing bodies have on shaping favorable KAP. As a result, it's crucial for local government platforms to prioritize the dissemination of up-to-date information that aligns with international standards. This information should be tailored to the specific region, focusing on addressing deficiencies in healthcare practices and patient management. The identification of a significant number of HCWs lacking confidence in managing COVID-19 patients and feeling unprotected underscores a clear need for improvement in their understanding and implementation of preventive measures. This gap can be bridged by adequately equipping HCWs with locally manufactured PPEs. This aspect is crucial for pandemic preparedness, and we further advocate for the creation of a locally produced repository of medical equipment. These actions are pivotal in improving future crisis management capabilities.

The RdRp genotyping of SARS-CoV-2 isolated from patients with different clinical spectrum of COVID-19

BACKGROUND

The evolution of SARS-CoV-2 has been observed from the very beginning of the fight against COVID-19, some mutations are indicators of potentially dangerous variants of the virus. However, there is no clear association between the genetic variants of SARS-CoV-2 and the severity of COVID-19. We aimed to analyze the genetic variability of RdRp in correlation with different courses of COVID-19.

RESULTS

The prospective study included 77 samples of SARS-CoV-2 isolated from outpatients (1st degree of severity) and hospitalized patients (2nd, 3rd and 4th degree of severity). The retrospective analyses included 15,898,266 cases of SARS-CoV-2 genome sequences deposited in the GISAID repository. Single-nucleotide variants were identified based on the four sequenced amplified fragments of SARS-CoV-2. The analysis of the results was performed using appropriate statistical methods, with p < 0.05, considered statistically significant. Additionally, logistic regression analysis was performed to predict the strongest determinants of the observed relationships. The number of mutations was positively correlated with the severity of the COVID-19, and older male patients. We detected four mutations that significantly increased the risk of hospitalization of COVID-19 patients (14676C > T, 14697C > T, 15096 T > C, and 15279C > T), while the 15240C > T mutation was common among strains isolated from outpatients. The selected mutations were searched worldwide in the GISAID database, their presence was correlated with the severity of COVID-19.

CONCLUSION

Identified mutations have the potential to be used to assess the increased risk of hospitalization in COVID-19 positive patients. Experimental studies and extensive epidemiological data are needed to investigate the association between individual mutations and the severity of COVID-19.

Epidemiological contemplation for a currently pragmatic COVID-19 health passport: a perspective

The coronavirus disease 2019 (COVID-19) has caused a global pandemic that has wreaked havoc on the lives of millions of people around the world. Confinement measures aim to reduce the epidemic's spread and minimize the burden of morbidity and mortality. In response to the challenges caused by the pandemic, digital health passports have been developed exponentially. We highlight the latent epidemiological barriers to health passports to achieve standardized digital care platforms. This review paper not only highlights the epidemiological barriers but also articulates the possible infrastructure required to make the International Standard for a multi-factor authenticated and validated health passport.

Gene expression of protein kinase AMP-activated catalytic subunit alpha 1 (PRKAA1), solute carrier family 2 member 1 (SLC2A1) and mechanistic target of rapamycin (MTOR) in metformin-treated type 2 diabetes patients with COVID-19: impact on inflammation markers

The COVID-19 pandemic has resulted in a global health crisis that has severely impacted patients with type 2 diabetes (T2D). T2D patients have a higher risk of experiencing severe COVID-19 symptoms, hospitalization, and mortality compared to patients without diabetes. The dysregulated immune response in T2D patients can exacerbate the severity of COVID-19 symptoms. Insulin therapy, a common treatment for T2D patients, has been linked to increased mortality in COVID-19 patients with T2D. However, metformin, an anti-diabetic medication, has been shown to have anti-inflammatory properties that may mitigate the cytokine storm observed in severe COVID-19 cases. In this study, we investigated how the PRKAA1, SLC2A1, and MTOR genes contribute to inflammation markers in COVID-19 patients with T2D, who were receiving either insulin or metformin therapy. Our findings revealed that metformin treatment was associated with reduced expression of genes involved in Th1/Th17 cell differentiation. These results suggest that metformin could be a potential treatment option for T2D patients with COVID-19 due to its anti-inflammatory properties, which may improve patient outcomes.

Impact of Coronavirus Disease 2019 (COVID-19) Pandemic on Surgical Site Infection in Patients with Inflammatory Bowel Disease-A Monocentric, Retrospective Cohort Study

(1) Background: Surgical site infections (SSIs) are a relevant problem with a 25% incidence rate after elective laparotomy due to inflammatory bowel disease (IBD). The aim of this study was to evaluate whether stricter hygienic measures during the COVID-19 pandemic influenced the rate of SSI. (2) Methods: This is a monocentric, retrospective cohort study comparing the rate of SSI in patients with bowel resection due to IBD during COVID-19 (1 March 2020-15 December 2021) to a cohort pre-COVID-19 (1 February 2015-25 May 2018). (3) Results: The rate of SSI in IBD patients with bowel resection was 25.8% during the COVID-19 pandemic compared to 31.8% pre-COVID-19 (OR 0.94; 95% CI 0.40-2.20; p = 0.881). There were seventeen (17.5%) superficial and four (4.1%) deep incisional and organ/space SSIs, respectively, during the COVID-19 pandemic (p = 0.216). There were more postoperative intra-abdominal abscesses during COVID-19 (7.2% vs. 0.9%; p = 0.021). The strictness of hygienic measures (mild, medium, strict) had no influence on the rate of SSI (p = 0.553). (4) Conclusions: Hygienic regulations in hospitals during COVID-19 did not significantly reduce the rate of SSI in patients with bowel resection due to IBD. A ban on surgery, whereby only emergency surgery was allowed, was likely to delay surgery and exacerbate the disease, which probably contributed to more SSIs and postoperative complications.

Enhanced neutralization of SARS-CoV-2 variant BA.2.86 and XBB sub-lineages by a tetravalent COVID-19 vaccine booster

Emerging SARS-CoV-2 sub-lineages like XBB.1.5, XBB.1.16, EG.5, HK.3 (FLip), and XBB.2.3 and the variant BA.2.86 have recently been identified. Understanding the efficacy of current vaccines on these emerging variants is critical. We evaluate the serum neutralization activities of participants who received COVID-19 inactivated vaccine (CoronaVac), those who received the recently approved tetravalent protein vaccine (SCTV01E), or those who had contracted a breakthrough infection with BA.5/BF.7/XBB virus. Neutralization profiles against a broad panel of 30 sub-lineages reveal that BQ.1.1, CH.1.1, and all the XBB sub-lineages exhibit heightened resistance to neutralization compared to previous variants. However, despite their extra mutations, BA.2.86 and the emerging XBB sub-lineages do not demonstrate significantly increased resistance to neutralization over XBB.1.5. Encouragingly, the SCTV01E booster consistently induces higher neutralizing titers against all these variants than breakthrough infection does. Cellular immunity assays also show that the SCTV01E booster elicits a higher frequency of virus-specific memory B cells. Our findings support the development of multivalent vaccines to combat future variants.

'Pterocephalodes hookeri-Onosma hookeri' decoction protects against LPS-induced pulmonary inflammation via inhibiting TLR4/ NF-κB signaling pathway

ETHNOPHARMACOLOGICAL RELEVANCE

As the second-largest traditional medical system in China, Tibetan medicine has a long history and abundant resources. To promote the development of the Tibetan medicine industry, it is essential to study the pharmacological activities of Tibetan medicine based on its traditional usage methods.

AIM OF THE STUDY

Pneumonia has been a worldwide health problem with high morbidity and mortality rates, especially in the context of the COVID-19 epidemic. Given the unique advantages of traditional Tibetan medicine in treating pulmonary diseases, further research is warranted to develop potential anti-pneumonia drugs.

MATERIALS AND METHODS

In our study, the potential combined decoction from traditional Tibetan medicine was determined by the data mining method. The antioxidant activity in vitro, anti-inflammatory effects on the macrophage cell model, as well as the anti-pulmonary inflammation effects on the LPS-induced mice model, have been explored to investigate the potential anti-pneumonia role of the decoction. Additionally, we conducted network pharmacology analysis to identify the potential targets against pneumonia, which were further confirmed by western blot assays.

RESULTS

Following the combination therapy of Pterocephalodes hookeri (C.B.Clarke) V.Mayer & Ehrend. and Onosma hookeri var. longiflora (Duthie) A.V.Duthie ex Stapf ('P-O'), the clearance of DPPH radical and the total reducing power were all improved, as well as alleviated the toxicity. On the in vitro level, 'P-O' pre-treatment reduced the secretion of NO, TNF-α, IL-6, and IL-1β in LPS-stimulated RAW264.7 cells, while promoting the concentration of IL-10. Meanwhile, on the in vivo level, the 'P-O' pre-treating also could alleviate LPS-induced pulmonary inflammation by reducing the pulmonary edema and leakage of the lung microvascular, improving the pathological change of lung tissue and regulating the cytokines content in bronchoalveolar lavage fluid (BALF). Furthermore, network pharmacology analysis revealed that the mechanism of 'P-O' in treating pneumonia in a multi-component, multi-target, and multi-pathway network, with the TLR4/NF-κB signaling pathway playing a crucial role, as demonstrated by the western blot assay results.

CONCLUSION

In summary, the combination therapy of 'P-O' exhibited good antioxidant activity and anti-inflammatory activity in vitro, as well as a therapeutic effect against pulmonary inflammation in vivo. These findings provide evidence for the clinical application of 'P-O' and offer new approaches for treating pneumonia.

Evaluating the impact of COVID-19 outbreak on hepatitis B and forecasting the epidemiological trend in mainland China: a causal analysis

BACKGROUND

It is uncertain how COVID-19 outbreak influences the hepatitis B epidemics. This study aims to evaluate the effects on hepatitis B owing to the COVID-19 outbreak and forecast the hepatitis B epidemiological trend in mainland China to speed up the course of the "End viral hepatitis Strategy".

METHODS

We estimated the causal impacts and created a forecast through adopting monthly notifications of hepatitis B each year from 2005 to 2020 in mainland China using the Bayesian structural time series (BSTS) method.

RESULTS

The hepatitis B epidemics fluctuates irregularly during the period 2005-2007(APC = 8.7, P = 0.246) and 2015-2020(APC = 1.7, P = 0.290), and there is a downturn (APC=-3.2, 95% CI -5.2 to -1.2, P = 0.006) from 2007 to 2015 in mainland China. The COVID-19 outbreak was found to have a monthly average reduction on the hepatitis B epidemics of 26% (95% CI 18-35%) within the first three months in 2020,17% (95% CI 7.7-26%) within the first six months in 2020, and 10% (95% CI19-22%) all year as a result of the COVID-19 outbreak, (probability of causal effect = 96.591%, P = 0.034) and the forecasts showed an upward trend from 2021 to 2025 (annual percentage change = 4.18, 95% CI 4.0 to 4.3, P < 0.001).

CONCLUSION

The COVID-19 has a positive effect on the decline of hepatitis B cases. And the potential of BSTS model to forecast the epidemiological trend of the hepatitis B can be applied in automatic public health policymaking in mainland China.

A Correlation Study to Comprehend the SAR-CoV-2 Viral Load, Antiviral Antibody Titer, and Severity of COVID-19 Symptoms Post-infection Amongst the Vaccinated Population in Kamrup District of As sam, Northeast India

BACKGROUND

As per the recommendation of the United States Food and Drug Administration, more research is needed to determine the antibody titer against COVID-19 vaccination.

OBJECTIVE

The study aimed to understand the relationship between the antibody titer to the demographics, infection severity, and cycle threshold (CT) values of confirmed COVID-19 patients.

METHODS

Initially, we obtained consent from 185 populations and included sixty RT-PCRpositive COVID-19 patients from Kamrup District in the Northeast State of Assam, India. The vaccination status was recorded and tested for the level of serum immunoglobulin (IgG). The CT values, gender, and clinical symptoms-based scoring (CSBS) correlated with their IgG value.

RESULTS

Around 48% of participants gained an antibody titer more than the threshold value and showed CT values between 18-25. Moreover, the maximum distributed score above the average was found between the CT values 18-25.

CONCLUSION

The IgG titer value differs significantly amongst the vaccinated population, which may depend upon their genetic and demographic variability.

Performance of an AI algorithm during the different phases of the COVID pandemics: what can we learn from the AI and vice versa

Background

Artificial intelligence (AI) has proved to be of great value in diagnosing and managing Sars-Cov-2 infection. ALFABETO (ALL-FAster-BEtter-TOgether) is a tool created to support healthcare professionals in the triage, mainly in optimizing hospital admissions.

Methods

The AI was trained during the pandemic's "first wave" (February-April 2020). Our aim was to assess the performance during the "third wave" of the pandemics (February-April 2021) and evaluate its evolution. The neural network proposed behavior (hospitalization vs home care) was compared with what was actually done. If there were discrepancies between ALFABETO's predictions and clinicians' decisions, the disease's progression was monitored. Clinical course was defined as "favorable/mild" if patients could be managed at home or in spoke centers and "unfavorable/severe" if patients need to be managed in a hub center.

Results

ALFABETO showed accuracy of 76%, AUROC of 83%; specificity was 78% and recall 74%. ALFABETO also showed high precision (88%). 81 hospitalized patients were incorrectly predicted to be in "home care" class. Among those "home-cared" by the AI and "hospitalized" by the clinicians, 3 out of 4 misclassified patients (76.5%) showed a favorable/mild clinical course. ALFABETO's performance matched the reports in literature.

Conclusions

The discrepancies mostly occurred when the AI predicted patients could stay at home but clinicians hospitalized them; these cases could be handled in spoke centers rather than hubs, and the discrepancies may aid clinicians in patient selection. The interaction between AI and human experience has the potential to improve both AI performance and our comprehension of pandemic management.

Universal Screening for SARS-CoV-2 in Obstetric Care: Clinical Characteristics and Maternofetal Outcomes in a Latin American High-Complexity Unit

The asymptomatic population's role in COVID-19 transmission poses challenges for control efforts. Pregnant women are susceptible to severe manifestations, increasing maternal and perinatal morbidity and mortality. This study describes the clinical characteristics, maternal and fetal outcomes, and our experience in universal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) screening of pregnant women admitted to a high-complexity obstetric unit in Latin America. Of 568 pregnant women tested for SARS-CoV-2, 23 obtained a positive result. Among these patients, 17% had symptoms at admission, and 0.2% reported an epidemiological link. Pregnant women with positive were associated with an increased risk of eclampsia (16.7% vs 4.9%, P = .014) and acute respiratory distress (16.7% vs 4.9%, P = .014). In this group, 4 patients developed maternal near misses, and no maternal deaths were noted. Two early perinatal deaths occurred in the positive SARS-CoV-2 test group (2, 9.5% vs 17, 4.1%, P = .235). The high prevalence of asymptomatic pregnant women with SARS-CoV-2 and the adverse outcomes for those infected during pregnancy highlights the importance of universal screening upon hospital admission. This approach streamlines risk management, and enhances service structure, resource allocation, care pathways, patient management, follow-up, and overall outcomes.

The role of the behavioural immune system on covid-19 lockdown attitudes: The relationship with authoritarianism and collectivism

Background and objectives

The behavioural immune system (BIS) is a motivational system that facilitates the avoidance of pathogens and is thought to have evolved as a less costly mechanism to combat infectious diseases compared to the physiological immune system. The Parasite Stress Theory of Social Values predicts that authoritarianism and collectivist attitudes may impact the BIS by predisposing people to support disease control measures, including severe restrictions like lockdowns or stay-at-home orders. This study investigates the relationship between authoritarianism, collectivism and Covid-19 worry on support for lockdown measures during the Covid-19 pandemic.

Methodology

A total of 187 UK participants were recruited to complete an online survey, which was administered between 22 June and 7 July 2020. The survey included measures of authoritarianism, collectivism, Covid-19 worry and support for lockdown measures. The data were analysed using moderated parallel mediation analysis.

Results

Covid-19 worry had a direct effect on support for and enforcement of lockdown measures, but not on the idea that adherence to lockdown rules should be an individual choice. The relationship between Covid Worry and Support for and Enforcement of lockdown measures was not mediated by authoritarianism, nor was it moderated by Collectivism. Collectivism and Authoritarianism were related to increased levels of support for lockdown independently from Covid Worry but were not related to enforcement.

Conclusions and implications

Support for lockdown restrictions and enforcement was mainly associated with covid worry. Our findings do not support the parasite stress theory of social values and indicate that the BIS manifested in a more direct way, and not through social values.

No Changes in the Occurrence of Methicillin-Resistant Staphylococcus aureus (MRSA) in South-East Austria during the COVID-19 Pandemic

Methicillin-resistant Staphylococcus aureus (MRSA) is a universal threat. Once being well established in the healthcare setting, MRSA has undergone various epidemiological changes. This includes the emergence of more aggressive community-acquired MRSA (CA-MRSA) and the occurrence of MRSA which have their origin in animal breeding, called livestock-associated MRSA (LA-MRSA). Emergence of new clones as well as changes in the occurrence of some clonal lineages also describes the fluctuating dynamic within the MRSA family. There is paucity of data describing the possible impact of the COVID-19 pandemic on the MRSA dynamics. The aim of the study was the analysis of MRSA isolates in a three-year time period, including the pre-COVID-19 years 2018 and 2019 and the first year of the pandemic 2020. The analysis includes prevalence determination, antibiotic susceptibility testing, spa typing, and detection of genes encoding the PVL toxin. The MRSA rate remained constant throughout the study period. In terms of a dynamic within the MRSA family, only a few significant changes could be observed, but all except one occurred before the start of the COVID-19 pandemic. In summary, there was no significant impact of the COVID-19 pandemic on MRSA in Austria.

The N-terminal peptide of the main protease of SARS-CoV-2, targeting dimer interface, inhibits its proteolytic activity

The main protease (Mpro) of SARS-CoV-2 cleaves 11 sites of iral polypeptide chains and generates essential non-structural proteins for viral replication. Mpro is an important drug target against COVID-19. In this study, we developed a real-time fluorometric turn-on assay system to evaluate Mpro proteolytic activity for a substrate peptide between NSP4 and NSP5. It produced reproducible and reliable results suitable for HTS inhibitor assays. Thus far, most inhibitors against Mpro target the active site for substrate binding. Mpro exists as a dimer, which is essential for its activity. We investigated the potential of the Mpro dimer interface to act as a drug target. The dimer interface is formed of domain II and domain III of each protomer, in which N-terminal ten amino acids of the domain I are bound in the middle as a sandwich. The N-terminal part provides approximately 39% of the dimer interface between two protomers. In the real-time fluorometric turn-on assay system, peptides of the N-terminal ten amino acids, N10, can inhibit the Mpro activity. The dimer interface could be a prospective drug target against Mpro. The N-terminal sequence can help develop a potential inhibitor. [BMB Reports 2023; 56(11): 606-611].

Monocytes subpopulations pattern in the acute respiratory syndrome coronavirus 2 virus infection and after long COVID-19

INTRODUTION AND OBJECTIVE

The present study sought to characterize the pattern of monocyte subpopulations in patients during the course of the infections caused by SARS-CoV-2 virus or who presented long COVID-19 syndrome compared to monocytes from patients with zika virus (Zika) or chikungunya virus (CHIKV).

CASUISTRY

Study with 89 peripheral blood samples from patients, who underwent hemogram and serology (IgG and IgM) for detection of Zika (Control Group 1, n = 18) or CHIKV (Control Group 2, n = 9), and from patients who underwent hemogram and reverse transcription polymerase chain reaction for detection of SARS-CoV-2 at the acute phase of the disease (Group 3, n = 19); and of patients who presented long COVID-19 syndrome (Group 4, n = 43). The monocyte and subpopulations counts were performed by flow cytometry.

RESULTS

No significant difference was observed in the total number of monocytes between the groups. The classical (CD14++CD16-) and intermediate (CD14+CD16+) monocytes counts were increased in patients with acute infection or with long COVID-19 syndrome. The monocytes subpopulations counts were lower in patients with infection Zika or CHIKV.

CONCLUSION

Increase in the monocyte subpopulations in patients with acute infection or with long COVID-19 syndrome may be an important finding of differentiated from the infection Zika or CHIKV.

Harnessing digital technology for COVID-19 response in Uganda: lessons and implications for future public health emergencies

COVID-19 was one of the greatest disruptors of the 21st century, causing significant morbidity and mortality globally. Countries around the world adopted digital technologies and innovations to support the containment of the pandemic. This study explored the use of digital technology and barriers to its utilisation in responding to COVID-19 and sustaining essential health services in Uganda to inform response to future public health emergencies in low-resource settings. We reviewed published and grey literature on the use of digital technology in Uganda's response from March 2020 to April 2021 and conducted interviews with key informants. We thematically synthesised and summarised information on digital technology use as well as related challenges. During the COVID-19 response, digital technology was used in testing, contact tracing and surveillance, risk communication, supportive supervision and training, and maintenance of essential health services. The challenges with technology use were the disparate digital tools and health information systems leading to duplication of effort; limited access and coverage of digital tools, poor data quality; inaccessibility of data and an inability to support data manipulation, analysis and visualisation. Moreover, the inherent inadequate technology support systems such as poor internet and electricity infrastructure in some areas posed challenges of inequity. The harnessing of technology was key in supporting the COVID-19 response in Uganda. However, gaps existed in access, adoption, harmonisation, evaluation, sustainability and scale up of technology options. These issues should be addressed in preparedness efforts to foster technology adoption and application in public health emergencies with a focus on equity.

The role of cell death in SARS-CoV-2 infection

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), showing high infectiousness, resulted in an ongoing pandemic termed coronavirus disease 2019 (COVID-19). COVID-19 cases often experience acute respiratory distress syndrome, which has caused millions of deaths. Apart from triggering inflammatory and immune responses, many viral infections can cause programmed cell death in infected cells. Cell death mechanisms have a vital role in maintaining a suitable environment to achieve normal cell functionality. Nonetheless, these processes are dysregulated, potentially contributing to disease pathogenesis. Over the past decades, multiple cell death pathways are becoming better understood. Growing evidence suggests that the induction of cell death by the coronavirus may significantly contributes to viral infection and pathogenicity. However, the interaction of SARS-CoV-2 with cell death, together with its associated mechanisms, is yet to be elucidated. In this review, we summarize the existing evidence concerning the molecular modulation of cell death in SARS-CoV-2 infection as well as viral-host interactions, which may shed new light on antiviral therapy against SARS-CoV-2.

Primary care physicians' strategies for addressing COVID-19 vaccine hesitancy

OBJECTIVE

To explore the strategies that primary care physicians use to address patient COVID-19 vaccine hesitancy.

METHOD

We administered an online survey to 625 primary care physicians from May 14 to May 25, 2021, to assess the messages that primary care physicians use to encourage hesitant patients to get vaccinated against COVID-19.589 physicians from the total pool of 625 provided open-ended responses. We conducted thematic content analysis on the responses based on previous research and themes identified within the data.

SETTING

The survey was administered online using the survey research firm Dynata.

RESULTS

Eleven primary themes emerged from our analysis, which included, physicians addressing specific concerns about vaccine safety (including costs versus benefits), physicians helping patients understand what it means to remain unvaccinated, or whether physicians try to connect emotionally through the use of guilt, or personal experience, whether physicians use derisive language to communicate with unvaccinated patients. In addition, a small number of physicians indicated they would not attempt to persuade someone who is vaccine hesitant.

CONCLUSIONS

Our study shows that while some of the physicians used different strategies to address vaccine hesitancy, some of the physicians used harsh language or did not make any effort to reduce COVID-19 related vaccine hesitancy among their patients. Focused advocacy and training are needed to increase physician engagement in vaccine-related dialogues with their patients. Such efforts will ensure that critical opportunities for patient education and awareness-building are not missed and ensure high levels of vaccination uptake.

Outcomes of hip fracture surgery during the COVID-19 pandemic

PURPOSE

To investigate if changes to hospital operational models during the COVID-19 pandemic negatively impacted overall time to surgery (TtS) as well as morbidity and mortality rates of hip fractures (HFx).

METHODS

416 patients treated for OTA 31 fractures at a single institution between January 2019 and November 2020 were reviewed. TtS as well as morbidity and mortality rates were obtained from pre-pandemic and pandemic groups.

RESULTS

263 patients were treated pre-pandemic and 153 were treated during the pandemic. There were no significant differences in median TtS, readmission rates (p = 0.134), reoperation rates (p = 0.052), 30-day (p = 0.095) and 90-day (p = 0.22) mortality rates.

CONCLUSION

Reallocation of hospital resources in response to the COVID-19 pandemic did not negatively impact surgical timing or complications. TtS for HFx remains a challenge and often requires multidisciplinary care, which is complicated by a pandemic. However, this study demonstrates HFx standard of care can be maintained despite COVID-19 obstacles to treatment efficiency and efficacy.

Hesitancy toward vaccination against COVID-19: A scoping review of prevalence and associated factors in the Arab world

Despite widespread availability of vaccines against SARS-CoV-2 virus, the cause of Coronavirus Disease 2019 (COVID-19), its uptake in many Arab countries is relatively low. This literature review aimed to scope evidence on COVID-19 vaccine hesitancy (VH) in the Arab world. A total of 134 articles reporting prevalence of COVID-19 VH and associated factors, conducted in any of the 22 Arab League countries, were reviewed. COVID-19 VH prevalence ranged from 5.4% to 83.0%. Female gender, young age, low education level and lack of previous influenza vaccine uptake were most commonly reported to be associated with COVID-19 VH. The most-reported personal concerns contributing toward VH were related to the rapid development, safety and side effects of vaccine, as well as an overall lack of trust in government policies toward pandemic control and widespread conspiracy theories. Tailored interventions to enable the distribution of trusted information and enhance public acceptance of immunization are warranted.

Triangular Silver Nanoplates as a Bioanalytical Tool: Potential COVID-19 Detection

Nanotechnology offers new possibilities in molecular diagnostics, with nanoparticles gaining attention as biosensor upgrades. This study evaluates gold-coated silver nanoplates coated with PEG for enhanced protection, aiming to detect Spike protein with higher sensitivity, and emphasizes the importance of considering complex environments and appropriate controls for specific binding and accurate analysis. The sensitivity of antibody-coated PEGAuTSNPs as tools for immunoassays is demonstrated through fibronectin (Fn)- anti-fibronectin binding within an isolated extracellular matrix as a complex and native environment of Fn. Moreover, the optimal functionalization volume of Spike protein was determined (4 µg/mL of PEGAuTSNP). Anti-Spike was added to confirm binding, while the TJP1 protein was used as a negative control. The same experiment was used in the presence of horse serum to simulate a complex environment. According to Localized Surface Plasmon Resonance analysis and Dynamic Light Scattering size measurements, anti-Spike exhibited a stronger affinity for the nanoplates, causing TJP1 to be replaced by the antibody on the nanoplates' surface. Future research will involve exploring alternative complex environments, filtering larger molecules, and the optimization of immunoassay performance.

Preclinical evaluation of PHH-1V vaccine candidate against SARS-CoV-2 in non-human primates

SARS-CoV-2 emerged in December 2019 and quickly spread worldwide, continuously striking with an unpredictable evolution. Despite the success in vaccine production and mass vaccination programs, the situation is not still completely controlled, and therefore accessible second-generation vaccines are required to mitigate the pandemic. We previously developed an adjuvanted vaccine candidate coded PHH-1V, based on a heterodimer fusion protein comprising the RBD domain of two SARS-CoV-2 variants. Here, we report data on the efficacy, safety, and immunogenicity of PHH-1V in cynomolgus macaques. PHH-1V prime-boost vaccination induces high levels of RBD-specific IgG binding and neutralizing antibodies against several SARS-CoV-2 variants, as well as a balanced Th1/Th2 cellular immune response. Remarkably, PHH-1V vaccination prevents SARS-CoV-2 replication in the lower respiratory tract and significantly reduces viral load in the upper respiratory tract after an experimental infection. These results highlight the potential use of the PHH-1V vaccine in humans, currently undergoing Phase III clinical trials.

Olfactory Dysfunction following COVID-19 and the Potential Benefits of Olfactory Training

COVID-19 is associated with a common symptom of olfactory dysfunction, which may persist even after the infection is resolved. Olfactory training (OT) has emerged as the most effective intervention for post-viral olfactory dysfunction. OT involves daily exposure of the olfactory system to various odors. The current study aims to explore olfactory dysfunction following COVID-19 and the potential benefits of olfactory training.

METHODS

This is a cross-sectional study conducted among adults aged 18-60 living in Alahssa, Saudi Arabia. An online questionnaire containing an informed consent form and a survey to collect demographic data, vaccination status, level of loss of smell and taste, and the level of awareness about olfactory training (OT) was distributed among all participants who agreed to participate in this study.

RESULTS

The study included 524 participants and presented their baseline characteristics, including age, gender, COVID-19 infection status, and complaints. Most patients were female (66.0%), and 46.2% had previously been infected with COVID-19. About 54.8% of participants reported chemosensory dysfunction, while 286 had olfactory dysfunction. Of those, 29.8% had anosmia, 16.8% had hyposmia, and 8.0% had parosmia. Results suggest that being fully or partially vaccinated may offer some protection against olfactory dysfunction compared to being unvaccinated. Adherence to olfactory training was associated with improvement in the sense of smell.

CONCLUSIONS

The study highlights the importance of awareness and adherence to olfactory training, which may improve the sense of smell in individuals with chemosensory dysfunction. The findings of this study can inform public health policies and interventions aimed at reducing the burden of olfactory dysfunction associated with COVID-19 vaccination.

The COVID-19 pandemic and its impact on health experiences of asylum seekers to the United States

BACKGROUND

The COVID-19 pandemic exacerbated preexisting barriers to accessing healthcare and social services faced by asylum seekers to the United States. This study aimed to uncover the impact of the first year of the COVID-19 pandemic on asylum seekers, including socio-economic stressors and access to medical information, healthcare, and testing.

METHOD

We conducted 15 semi-structured, in-depth interviews with adult asylum seekers to the U.S. and systematically analyzed the resulting transcripts using a consensual qualitative research approach.

RESULTS

The transcripts yielded six domains: (1) knowledge and understanding of COVID-19; (2) attitudes and practices relating to COVID-19 precautions; (3) experience of COVID-19 symptoms; (4) current physical and mental health; (5) access to and interaction with health care; (6) discrimination based on asylum status.

CONCLUSIONS

Although participants had knowledge about COVID-19's communicability and regularly used masks, their living conditions frequently hindered their ability to quarantine and isolate, and their lack of insurance was often a deterrent to them seeking medical care. Notably, immigration status was not a significant factor discouraging participants from seeking care during the pandemic. The findings build on existing knowledge about this community and may help define areas where support and services can be expanded in current and future pandemics.

Validation of the Iranian version of the Postpartum Specific Anxiety Scale 12-item research short-form for use during global crises (PSAS-IR-RSF-C)

BACKGROUND

Due to its high pervasiveness and adversarial consequences, postpartum anxiety has been one of the most worrying public health concerns in the last decade. According to previous research, the occurrence of mental disorders among women in the postpartum period upsurges significantly in the course of universal disasters. The Postpartum Specific Anxiety Scale - Research Short Form - for use in global Crises [PSAS-IR-RSF-C] has not been used in Iran for postpartum women during a health system shock. Consequently, this study was conducted to determine the validity and reliability of the Persian version (PSAS-IR-RSF-C) during the COVID-19 pandemic.

METHODS

This cross-sectional study was performed with 180 women who were between six weeks and six months after delivery, by random sampling method from December 2021 to June 2022. The validity of the PSAS-RSF-C in terms of face, content, was analyzed, and the construct validity was assessed using exploratory and confirmatory factor analyses. Internal consistency and test-retest reliability of the questionnaire were measured using (Cronbach's alpha, McDonald's ω) and intraclass correlation coefficient (ICC), respectively.

RESULTS

The content validity index and content validity ratio of the Persian version of the PSAS-IR-RSF-C were 0.96 and 0.98, respectively. A three-factor structure was extracted during the exploratory factor analysis process, and model validity was confirmed by the values of fit indices. Cronbach's alpha coefficient, McDonald's ω and intra-cluster correlation coefficient (95% confidence interval) were 0.74, 0.92 (0.78 to 0.93) and 0.97 (0.93 to 0.98), respectively.

CONCLUSIONS

For the specific assessment of postpartum anxiety among Iranian women during crises, the Persian version of the PSAS-IR-RSF-C is a valid and reliable tool.

Fungal Infections Identified with Multiplex PCR in Severe COVID-19 Patients during Six Pandemic Waves

Background and Objectives: With an increasing number of severe COVID-19 cases presenting with secondary fungal infections, this study aimed to determine the prevalence of fungal co-infections in severe COVID-19 patients across the six waves, identify the most common fungal pathogens associated with severe COVID-19, and explore any potential links between patient characteristics, therapeutic strategies, and the prevalence and type of fungal infection. Materials and Methods: A retrospective analysis was conducted on severe COVID-19 patients admitted to the Infectious Diseases and Pulmonology Hospital, "Victor Babes", Romania, between March 2020 and August 2022. Samples were collected from respiratory specimens, blood, and urine, after which a standard nucleic acid extraction protocol was employed. Patients were divided into groups with and without fungal infections, identified using multiplex PCR. The groups were compared based on demographic data, comorbidities, pandemic wave number, and clinical outcomes. Results: Out of 288 patients, 96 (33.3%) had fungal infections, with Candida spp. being the most common. Patients with fungal infections had higher rates of obesity (35.4% vs. 21.4%, p = 0.010) and a higher Charlson comorbidity index (CCI > 2) (37.5% vs 25.0%, p = 0.027). Ventilator use was significantly higher in the fungal infection group (45.8% vs. 18.8%; p < 0.001), as was ICU admission (39.6% vs. 26.6%; p = 0.024) and mortality (32.3% vs 12.0%; p < 0.001). The distribution of different fungal species varied across the pandemic waves, with no statistical significance (p = 0.209). The mortality risk notably increased with the degree of drug resistance (OR for three or more drug resistances = 6.71, p < 0.001). The second, fourth, and fifth pandemic waves were significantly associated with higher mortality risk (OR = 3.72, 3.61, and 4.08, respectively, all p < 0.001). Aspergillus spp. and Mucor spp. infections were significantly associated with increased mortality risk (OR = 4.61 and 6.08, respectively, both p < 0.001). Conclusions: Our study indicates a significant presence of fungal co-infections among severe COVID-19 patients that is associated with increased morbidity and mortality, particularly in patients with drug-resistant infections. These findings underline the necessity for comprehensive diagnostic approaches and tailored treatment strategies in managing COVID-19 patients, especially during specific pandemic waves and in patients with particular fungal infections. Further research is required to understand the implications of these co-infections and their management.

Impact of COVID-19 Pandemic on Fragility Fractures of the Hip: An Interrupted Time-Series Analysis of the Lockdown Periods in Western Greece and Review of the Literature

Since December 2019, the COVID-19 pandemic has had a significant impact on healthcare systems worldwide, prompting policymakers to implement measures of isolation and eventually adopt strict national lockdowns, which affected mobility, healthcare-seeking behavior, and services, in an unprecedented manner. This study aimed to analyze the effects of these lockdowns on hip-fracture epidemiology and care services, compared to nonpandemic periods in previous years. We retrospectively collected data from electronic patient records of two major hospitals in Western Greece and included patients who suffered a fragility hip fracture and were admitted during the two 5-week lockdown periods in 2020, compared to time-matched patients from 2017-2019. The results showed a drop in hip-fracture incidence, which varied among hospitals and lockdown periods, and conflicting impacts on time to surgery, time to discharge after surgery, and total hospitalization time. The study also found that differences between the two differently organized units were exaggerated during the COVID-19 lockdown periods, highlighting the impact of compliance with social-distancing measures and the reallocation of resources on the quality of healthcare services. Further research is needed to fully understand the specific variations and patterns of geriatric hip-fracture care during emergency health crises characterized by limited resources and behavioral changes.

Lack of Evidence for a Role of ACE-2 Polymorphisms as a Bedside Clinical Prognostic Marker of COVID-19

The novel SARS-CoV-2 coronavirus causes a severe respiratory syndrome referred to as coronavirus disease (COVID-19). The angiotensin-converting enzyme 2 (ACE-2) plays an important role as a cellular receptor for SARS-CoV-2 and is largely expressed in lungs, kidneys, heart and the gastrointestinal tract along with being shed in plasma. The ACE-2 gene and protein show a high level of genetic polymorphism, including simple nucleotide variation, transcriptional variation, post-transcriptional changes, and putative protein mutations that could interfere with the binding or entry of SARS-CoV-2 and affect tissue damage in lungs or other organs. Genetic polymorphisms can impact SARS-CoV-2 viral entry and COVID-19 severity. This single-center study evaluated the possible role of the main ACE-2 polymorphisms (rs143936283, rs2285666, rs41303171, rs35803318, and rs2106809) as potential prognostic markers in SARS-CoV-2-infected individuals. Frozen whole blood was used for DNA isolation and genomic DNA samples were sheared using the Covaris LE220 Focused-ultrasonicator for targeting a peak size of 410 bp. Whole-genome sequencing libraries were generated from fragmented DNA using the Illumina TruSeq DNA PCR-Free HT Library Preparation Kit and sequenced on an Illumina NovaSeq 6000. We did not identify any correlation between ACE-2 polymorphisms and COVID-19 prognosis, suggesting that the interpretation and clinical use of ACE-2 genetic polymorphisms in real-world clinical settings requires further experimental and clinical validation.