Understanding of COVID-19 based on current evidence

Nigerian media coverage of medical progress on the development of COVID-19 vaccine

There is a global shift in discource on issues related to COVID-19 with greater attention paid to the vaccine. COVID-19. Despite this, the literature on media coverage of COVID-19 is yet to be extended to media coverage of issues related to medical progress on a vaccine for the virus. The objective of the current study was to fill this gap by examining how Nigerian media report COVID-19 vaccine development In doing so, attention was paid to the frequency of coverage, sources of stories as well as story type used. Two newspapers and TV stations were sampled for the current study. The current study made use of content analysis with a code sheet as the instrument for data collection. The result of the current study revealed that only 23% of the media stories on COVID-19 were related to vaccine development. Additionally, most of the stories made use of official sources as well as straight news. Comparatively, newspapers covered more in vaccine development than TV. The implications of these results on medical communication and theory are discussed.

Traditional Chinese Medicine and Western Medicine Share Similar Philosophical Approaches to Fight COVID-19

Though disciplines in the same field, modern medicine (Western medicine) and traditional medicine (Traditional Chinese medicine, TCM) have been viewed as two distinct and divergent fields of medicine and thus differ greatly in their ways of diagnosing, treating, and preventing disease. In brief, Western medicine is primarily an evidence (laboratory)-based science, whereas TCM is more of a healing art based on the theory of Yin and Yang and the five elements in the human body. Therefore, whether TCM and Western medicine could use similar philosophical approaches to treat disease remains unclear. It is well-known that vitamin D enhances immune function and reduces the spread of some viruses. Indeed, recent evidence shows that the blood calcium level is strongly associated with COVID-19 severity, and vitamin D supplementation has shown favorable effects in viral infections. According to TCM theory, the pathogenesis of COVID-19 is closely associated with cold-dampness, an etiological factor in TCM. Cold-dampness could be attenuated by sun exposure and Wenyang herbs, both of which can restore the vitamin D level in the blood in Western medicine. Therefore, TCM and Western medicine could share similar philosophical methods to fight COVID-19 and understanding their philosophical theories could achieve the maximum benefits for treatment of COVID-19 and other diseases.

Management of the Oral Health of Children During the COVID-19 Pandemic in Poland

Managing the oral health of children during the time of a health emergency linked to the current COVID-19 pandemic presents specific problems. A high number of non-specific effective infection control protocols are available in dental settings. It is of fundamental importance to implement specific protocols relating to those clinical situations that normally do not represent an emergency but which now fall into that category. The aim of this study was the comparison of data obtained from the Regional National Health Fund (NFZ) relating to the number and the type of procedures in the oral health management of children aged 0-18 years from the Wielkopolska region, with the months of March and April of 2019 being compared with those of the, respective, pandemic period of 2020. The results showed statistical differences in the number of performed procedures when comparing 2019 and 2020; especially in April (n = 53,077 in 2019 but only n = 2,287 in 2020), when lockdown restrictions reached their highest level and when only 30% of the dental clinics for children were open for patients in the Wielkopolska region of Poland. Regarding surgical cases, there were no differences in percentage frequency between April 2019 and 2020 in terms of extractions. However, an increase was observed in abscess incisions (3.5-17.8%) and surgical dressings (1.5-10.07%). There was a decrease in the total number of performed conservative dentistry procedures in April 2020, but temporary fillings in primary and permanent teeth showed a prominent increase: from 6.4% in 2019 to 19.3% in 2020; and 5.8-11.4%, respectively. Pulp treatment and mucosal lesions therapy fall into the dental emergency category during this COVID-19 pandemic. These cases have shown an increase from 3.2% in 2019 to 12.8% in 2020 for pulp treatment, and from 2.3 to 4.3% for the treatment of oral mucosal lesions. As suspected, after the lockdown was implemented, the number of pediatric dental cases were low. Moreover, the analysis revealed differences in the profile of clinical situations that represented the emergency cases and the pandemic treatment protocols. Future implications suggest that dental prophylactic procedures be included in pandemic protocols with even dental services being limited to a form of urgent treatment. New approaches and treatment models should be implemented in the control of the infectious spread of the disease in the management of the oral health of children in this pandemic period.

Perforated Appendicitis during a Pandemic: The Downstream Effect of COVID-19 in Children

Introduction

Coronavirus Disease-19 (COVID-19) was declared a pandemic in March 2020. States issued stay-at-home orders and hospitals cancelled non-emergent surgeries. During this time, we anecdotally noticed more admissions for perforated appendicitis. Therefore, we hypothesized that during the months following the COVID-19 pandemic declaration, more children were presenting with perforated appendicitis.

Materials and Methods

This is a retrospective cohort study reviewing pediatric patients admitted at a single institution with acute and/or perforated appendicitis between October 2019 to May 2020. Interval appendectomies were excluded. COVID-19 months were designated as March, April, and May 2020. Additional analysis of March, April, and May 2019 was performed for comparison purposes. Analyzed data included demographics, symptoms, white blood cell count, imaging findings, procedures performed, and perforation status. Statistical analysis was performed.

Results

During the study period, 285 patients were admitted with the diagnosis of acute appendicitis with 95 patients being perforated. We identified a significant increase in perforated appendicitis cases in the three COVID-19 months compared with the preceding five months (45.6% vs 26.4%; P <0.001). In addition, a similar significant increase was identified when comparing to the same months a year prior (P = 0.003). No significant difference in duration of pain was identified (P=0.926).

Conclusion

The COVID-19 pandemic and its associated stay-at-home orders have had downstream effects on healthcare. Our review has demonstrated a significant increase in the number of children presenting with perforated appendicitis following these stay-at-home ordinances. These results demonstrate that further investigations into the issues surrounding access to healthcare, especially during this pandemic, are warranted.

Keep out! SARS-CoV-2 entry inhibitors: their role and utility as COVID-19 therapeutics

The COVID-19 pandemic has put healthcare infrastructures and our social and economic lives under unprecedented strain. Effective solutions are needed to end the pandemic while significantly lessening its further impact on mortality and social and economic life. Effective and widely-available vaccines have appropriately long been seen as the best way to end the pandemic. Indeed, the current availability of several effective vaccines are already making a significant progress towards achieving that goal. Nevertheless, concerns have risen due to new SARS-CoV-2 variants that harbor mutations against which current vaccines are less effective. Furthermore, some individuals are unwilling or unable to take the vaccine. As health officials across the globe scramble to vaccinate their populations to reach herd immunity, the challenges noted above indicate that COVID-19 therapeutics are still needed to work alongside the vaccines. Here we describe the impact that neutralizing antibodies have had on those with early or mild COVID-19, and what their approval for early management of COVID-19 means for other viral entry inhibitors that have a similar mechanism of action. Importantly, we also highlight studies that show that therapeutic strategies involving various viral entry inhibitors such as multivalent antibodies, recombinant ACE2 and miniproteins can be effective not only for pre-exposure prophylaxis, but also in protecting against SARS-CoV-2 antigenic drift and future zoonotic sarbecoviruses.

Differential mutation profile of SARS-CoV-2 proteins across deceased and asymptomatic patients

BACKGROUND

The SARS-CoV-2 infection has spread at an alarming rate with many places showing multiple peaks in incidence. Present study analyzes a total of 332 SARS-CoV-2 genome sequences from 114 asymptomatic and 218 deceased patients from twenty-one different countries to assess the mutation profile therein in order to establish the correlation between the clinical status and the observed mutations.

METHODS

The mining of mutations was carried out using the GISAID CoVSurver (www.gisaid.org/epiflu-applications/covsurver-mutations-app) with the reference sequence 'hCoV-19/Wuhan/WIV04/2019' present in NCBI with Accession number NC-045512.2. The impact of the mutations on SARS-CoV-2 proteins mutation was predicted using PredictSNP1(loschmidt.chemi.muni.cz/predictsnp1) which is a meta-server integrating six predictor tools: SIFT, PhD-SNP, PolyPhen-1, PolyPhen-2, MAPP and SNAP. The iStable integrated server (predictor.nchu.edu.tw/iStable) was used to predict shifts in the protein stability due to mutations.

RESULTS

A total of 372 variants were observed in the 332 SARS-CoV-2 sequences with several variants present in multiple patients accounting for a total of 1596 incidences. Asymptomatic and deceased specific mutants constituted 32% and 62% of the repertoire respectively indicating their partial exclusivity. However, the most prevalent mutations were those present in both. Though some parts of the genome are more variable than others but there was clear difference between incidence and prevalence. Non-structural protein 3 (NSP3) with 68 variants had a total of only 105 incidences whereas Spike protein had 346 incidences with just 66 variants. Amongst the Deleterious variants, NSP3 had the highest incidence of 25 followed by NSP2 (16), ORF3a (14) and N (14). Spike protein had just 7 Deleterious variants out of 66.

CONCLUSION

Deceased patients have more Deleterious than Neutral variants as compared to the asymptomatic ones. Further, it appears that the Deleterious variants which decrease protein stability are more significant in pathogenicity of SARS-CoV-2.

Is RAS the Link Between COVID-19 and Increased Stress in Head and Neck Cancer Patients?

The COVID-19 pandemic emerged as a largely unexplained outbreak of pneumonia cases, in Wuhan City, China and rapidly spread across the world. By 11th March 2020, WHO declared it as a global pandemic. The resulting restrictions, to contain its spread, demanded a momentous change in the lifestyle of the general population as well as cancer patients. This augmented negative effects on the mental health of patients with head and neck cancer (HNC), who already battle with the stress of cancer diagnosis and treatment. The causative agent of COVID-19, SARS-CoV2, gains entry through the Angiotensin converting enzyme 2 (ACE2) receptor, which is a component of the Renin Angiotensin System (RAS). RAS has been shown to influence cancer and stress such that it can have progressive and suppressive effects on both. This review provides an overview of SARS-CoV2, looks at how the RAS provides a mechanistic link between stress, cancer and COVID-19 and the probable activation of the RAS axis that increase stress (anxiogenic) and tumor progression (tumorigenic), when ACE2 is hijacked by SARS-CoV2. The mental health crises brought about by this pandemic have been highlighted in many studies. The emerging links between cancer and stress make it more important than ever before to assess the stress burden of cancer patients and expand the strategies for its management.

Perceived Stress and Increased Food Consumption during the 'Third Wave' of the COVID-19 Pandemic in Spain

The COVID-19 pandemic has impacted the mental health of people worldwide. An increase in perceived stress can lead to unhealthy behaviors such as increased food consumption. The aim of this study was to find the level of perceived stress and its relationship with increased food consumption during the "third wave" of the COVID-19 pandemic in Spain. This was a cross-sectional study that employed anonline self-reported frequency of consumption questionnaire and the Perceived Stress Scale-10. A total of 637 subjects participated and 83.6% of respondents had moderate or high stress-more prevalent in the female and young respondents. Moreover, 36.1% of respondents reported that they had increased the frequency of consumption of some foods, mainly nuts, snacks, and jellybeans, along with coffee, tea, cocoa, and soft drinks. Eating between meals was more pronounced in those with high stress (65.1%) than in those with moderate stress (40.4%) and low stress (20.2%). Furthermore, the respondents with high stress reported greater weight gain. Thus, the results show that the level of perceived stress during the 'third wave' of this pandemic increased food consumption.

Nurses' Grief Counseling for Bereaved Family Members of COVID-19 Patients in Wuhan, China: A Cross-Sectional Survey

This is the first study to assess nurses' attitudes and skills regarding grief counseling for bereaved family members of patients who died from coronavirus disease 2019 (COVID-19) in Wuhan, China. Using a cross-sectional design, 412 nurses selected through convenience sampling completed a demographic characteristics survey, Attitudes of Grief Counseling Scale, (AGCS) and Skills of Grief Counseling Scale (SGCS). Average AGCS score was 32.89 (SD = 9.46), with an overall percentage rate score of 65.6%. Factors influencing attitudes toward grief counseling included other grief counseling skills, educational level, communication skills, and training related to grief counseling (p < 0.05). Average SGCS score was 18.81 (SD = 4.25), with an overall percentage rate score of 58.7%. Factors influencing skills of grief counseling included responsibilities and roles, frequency of contact with the bereaved, and positive view of grief counseling (p < 0.05). Nurses' attitudes and skills regarding grief counseling were low, indicating an urgent need to improve grief counseling. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].

The unfolding palette of COVID-19 multisystemic syndrome and its neurological manifestations

Although our current knowledge of the pathophysiology of COVID-19 is still fragmentary, the information so far accrued on the tropism and life cycle of its etiological agent SARS-CoV-2, together with the emerging clinical data, suffice to indicate that the severe acute pulmonary syndrome is the main, but not the only manifestation of COVID-19. Necropsy studies are increasingly revealing underlying endothelial vasculopathies in the form of micro-haemorrhages and micro-thrombi. Intertwined with defective antiviral responses, dysregulated coagulation mechanisms, abnormal hyper-inflammatory reactions and responses, COVID-19 is disclosing a wide pathophysiological palette. An additional property in categorising the disease is the combination of tissue (e.g. neuro- and vasculo-tropism) with organ tropism, whereby the virus preferentially attacks certain organs with highly developed capillary beds, such as the lungs, gastrointestinal tract, kidney and brain. These multiple clinical presentations confirm that the acute respiratory syndrome as described initially is increasingly unfolding as a more complex nosological entity, a multiorgan syndrome of systemic breadth. The neurological manifestations of COVID-19, the focus of this review, reflect this manifold nature of the disease.

CoronaPep: An Anti-Coronavirus Peptide Generation Tool

The novel coronavirus (COVID-19) infections have adopted the shape of a global pandemic now, demanding an urgent vaccine design. The current work reports contriving an anti-coronavirus peptide scanner tool to discern anti-coronavirus targets in the embodiment of peptides. The proffered CoronaPep tool features the fast fingerprinting of the anti-coronavirus target serving supreme prominence in the current bioinformatics research. The anti-coronavirus target protein sequences reported from the current outbreak are scanned against the anti-coronavirus target data-sets via CORONAPEP which provides precision-based anti-coronavirus peptides. This tool is specifically for the coronavirus data, which can predict peptides from the whole genome, or a gene or protein's list. Besides it is relatively fast, accurate, userfriendly and can generate maximum output from the limited information. The availability of tools like CORONAPEP will immeasurably perquisite researchers in the discipline of oncology and structure-based drug design.

Stress and anxiety among physicians during the COVID-19 outbreak in the Iraqi Kurdistan Region: An online survey

Background

During infectious disease outbreaks, healthcare workers are at high risk of infection, infecting others, and psychological distress. This study aimed to determine the prevalence of stress and anxiety in physicians during the COVID-19 outbreak in the Iraqi Kurdistan Region and assess their associated factors.

Methods

This cross-sectional study was carried out in Erbil, Iraqi Kurdistan Region, from March 28 to April 15, 2020. An online self-administered survey questionnaire was used to collect data from physicians working in specialized COVID-19 centers and other healthcare facilities. The level of stress was measured based on the 10-items Perceived Stress Scale. The level of anxiety was measured based on the 7-item Generalized Anxiety Disorder scale.

Results

A total of 370 participants responded to the perceived stress component of the survey, of whom 57 (15.4%) had low perceived stress, 249 (67.3%) had moderate stress, and 64 (17.3%) had high stress. Being female was significantly associated with having moderate/high stress (adjusted odds ratio (AOR) = 2.40 (95% CI 1.31–4.39)). A total of 201 participants responded to the generalized anxiety disorder component of the survey, of whom 19 (9.5%) had no anxiety, 57 (28.4%) had mild anxiety, 79 (39.3%) had moderate anxiety, and 46 (22.9%) had severe anxiety. Working in COVID-19 centers (AOR = 2.23 (95% CI 1.02–4.86)) and being general practitioners (AOR = 4.16 (95% CI 1.14–15.14)) were significantly associated with having moderate/severe anxiety.

Conclusion

A considerable proportion of physicians experience stress and anxiety during the COVID-19 outbreak in Iraqi Kurdistan region. Generalists and those in special COVID-19 units report the greatest anxiety. There a need to establish mechanisms to reduce the risks of stress and anxiety among physicians. Mental health coping interventions through counseling should be based on COVID-19 protocol guidelines. Interventions should also emphasize physicians’ ability to work safely and efficiently in providing care to the patients.

The Potential Use of Vitamin C to Prevent Kidney Injury in Patients with COVID-19

The newly found SARS-CoV-2 has led to the pandemic of COVID-19, which has caused respiratory distress syndrome and even death worldwide. This has become a global public health crisis. Unfortunately, elders and subjects with comorbidities have high mortality rates. One main feature of COVID-19 is the cytokine storm, which can cause damage in cells and tissues including the kidneys. Here, we reviewed the current literature on renal impairments in patients with COVID-19 and analyzed the possible etiology and mechanisms. In addition, we investigated the potential use of vitamin C for the prevention of renal injury in those patients. It appears that vitamin C could be helpful to improve the outcomes of patients with COVID-19. Lastly, we discussed the possible protective effects of vitamin C on renal functions in COVID-19 patients with existing kidney conditions.

Study of the Plasma and Buffy Coat in Patients with SARS-CoV-2 Infection-A Preliminary Report

The pandemic caused by the SARS-CoV-2 infection affects many aspects of public health knowledge, science, and practice around the world. Several studies have shown that SARS-CoV-2 RNA in plasma seems to be associated with a worse prognosis of COVID-19. In the present study, we investigated plasma and buffy RNA in patients with COVID-19 to determine its prognostic value. A prospective study was carried out in patients hospitalized for COVID-19, in which RNA was analyzed in plasma and the buffy coat. Morphological and immunohistochemical studies were used to detect the presence of SARS-CoV-2 in the buffy coat. In COVID-19 patients, the obtained RNA concentration in plasma was 448.3 ± 31.30 ng/mL. Of all the patients with positive plasma tests for SARS-CoV-2, 46.15% died from COVID-19. In four cases, tests revealed that SARS-CoV-2 was present in the buffy coat. Abnormal morphology of monocytes, lymphocytes and neutrophils was found. An immunohistochemical study showed positivity in mononuclear cells and platelets. Our results suggest that SARS-CoV-2 is present in the plasma. This facilitates viral dissemination and migration to specific organs, where SARS-CoV-2 infects target cells by binding to their receptors. In our study, the presence of plasma SARS-CoV-2 RNA was correlated with worse prognoses.

Coronavirus Disease (COVID-19): The Value of Chest Radiography for Patients Greater Than Age 50 Years at an Earlier Timepoint of Symptoms Compared With Younger Patients

Background: A relative paucity of data exists regarding chest radiography (CXR) in diagnosis of coronavirus disease (COVID-19) compared to computed tomography. We address the use of a strict pattern of CXR findings for COVID-19 diagnosis, specifically during early onset of symptoms with respect to patient age. Methods: We performed a retrospective study of patients under investigation for COVID-19 who presented to the emergency department during the COVID-19 outbreak of 2020 and had CXR within 1 week of symptoms. Only reverse transcription polymerase chain reaction (RT-PCR)-positive patients were included. Two board-certified radiologists, blinded to RT-PCR results, assessed 60 CXRs in consensus and assigned 1 of 3 patterns: characteristic, atypical, or negative. Atypical patterns were subdivided into more suspicious or less suspicious for COVID-19. Results: Sixty patients were included: 30 patients aged 52 to 88 years and 30 patients aged 19 to 48 years. Ninety-three percent of the older group demonstrated an abnormal CXR and were more likely to have characteristic and atypical-more suspicious findings in the first week after symptom onset than the younger group. The relationship between age and CXR findings was statistically significant (χ² [2, n=60]=15.70; P=0.00039). The relationship between negative and characteristic COVID-19 CXR findings between the 2 age cohorts was statistically significant with Fisher exact test resulting in a P value of 0.001. Conclusion: COVID-19 positive patients >50 years show earlier, characteristic patterns of statistically significant CXR changes than younger patients, suggesting that CXR is useful in the early diagnosis of infection. CXR can be useful in early diagnosis of COVID-19 in patients older than 50 years.

The Willingness to Receive COVID-19 Vaccine and Its Associated Factors: "Vaccination Refusal Could Prolong the War of This Pandemic" - A Systematic Review

BACKGROUND

The outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China, spreads globally, since its declaration by the World Health Organization (WHO) as a COVID-19 pandemic on March 11, 2020. COVID-19 vaccine is a crucial preventive approach that can halt this pandemic. The present systematic review was aimed to assess the level of willingness to receive COVID-19 vaccine and its associated factors.

METHODS

A comprehensive literature search was conducted by using various online databases such as PubMed/MEDLINE, HINARI, EMBASE, Google Scholar, Web of Science, Scopus, African journals, and Google for grey literature which were used to search the related articles up to the period of May 08, 2021.

RESULTS

The overall rate of participants' willingness to receive the COVID-19 vaccine was ranged from 27.7% to 91.3%, which was from Congo and China, respectively. Factors such as age, educational status, gender, income, residency, occupation, marital status, race/ethnicity, perceived risk of COVID-19, trust in healthcare system, health insurance, norms, attitude towards vaccine, perceived benefit of vaccine, perceived vaccine barriers, self-efficacy, up-to-date on vaccinations, tested for COVID-19 in the past, perceived efficacy of the COVID-19 vaccination, recommended for vaccination, political leaning, perceived severity of COVID-19, perceived effectiveness of COVID-19 vaccine, belief that vaccination makes them feel less worried about COVID-19, believing in mandatory COVID-19 vaccination, perceived potential vaccine harms, presence of chronic disease, confidence, COVID-19 vaccine safety concern, working in healthcare field, believing vaccines can stop the pandemic, fear about COVID-19, cues to action, COVID-19 vaccine hesitancy, complacency, and receiving any vaccine in the past 5 years were associated with the willingness of receive COVID-19 vaccine.

CONCLUSION

There were insufficient levels of willingness to receive COVID-19 vaccine, and several factors were associated with it. Health education should be provided concerning this vaccine to improve the willingness of the community.

An Overview of the Epidemiologic, Diagnostic and Treatment Approaches of COVID-19: What do We Know?

Background: In late December 2019, a new infectious respiratory disease (COVID-19) was reported in a number of patients with a history of exposure to the Huanan seafood market in China. The World Health Organization officially announced the COVID-19 pandemic on March 11, 2020. Here, we provided an overview of the epidemiologic, diagnostic and treatment approaches associated with COVID-19. Methods: We reviewed the publications indexed in major biomedical databases by December 20, 2020 or earlier (updated on May 16, 2021). Search keywords included a combination of: COVID-19, Coronavirus disease 2019, SARS-CoV-2, Epidemiology, Prevention, Diagnosis, Vaccine, and Treatment. We also used available information about COVID-19 from valid sources such as WHO. Results and Conclusion: At the time of writing this review, while most of the countries authorized COVID-19 vaccines for emergency use starting December 8, 2020, there is no a definite cure for it. This review synthesizes current knowledge of virology, epidemiology, clinical symptoms, diagnostic approaches, common treatment strategies, novel potential therapeutic options for control and prevention of COVID-19 infection, available vaccines, public health and clinical implications.

COVID-19 Testing Experience in a Resource-Limited Setting: The Use of Existing Facilities in Public Health Emergency Management

Introduction: Coronavirus disease 2019 (COVID-19) is a public health emergency with little testing and treatment experiences at its occurrence. Diagnostic and treatment rapidly changed in the world including Ethiopia. Haramaya University has strived to change its diagnostic capacity using existing facilities in response to the national call to the pandemic.

Objective: This summary aims to detail experiences of setting up COVID-19 testing in Haramaya University laboratories, Eastern Ethiopia.

Methods: Desktop exercise was conducted to understand the start-up and implementations of COVID-19 testing in two Haramaya University laboratories, Hararghe Health Research Partnership and Campylobacter Genomics and Environmental Enteric Dysfunction laboratories. Communication, formats, guidelines, and standards were reviewed and summarized. Discussion with those involved in the start-up and implementation of the testing were also held. Ideas were summarized to learn the experiences the COVID-19 testing exercises.

Lesson Learned: This is a huge experience for Haramaya University to participate in the national call to increase the testing platform in the management of COVID19. Close work relationship with the public health authorities at all levels demonstrated the university's commitment to public service. The university has used the opportunity to advance its molecular testing capability by training its staff and students. The University has also contributed to the capacity development for laboratories in the surrounding areas of Harar, Somali, Oromia, and Dire Dawa. The pandemic has been an opportunity in harnessing existing resource for the benefit of the public during such times of dire needs to provide critical public health laboratory interventions.

Disjoint and Functional Principal Component Analysis for Infected Cases and Deaths Due to COVID-19 in South American Countries with Sensor-Related Data

In this paper, we group South American countries based on the number of infected cases and deaths due to COVID-19. The countries considered are: Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Peru, Paraguay, Uruguay, and Venezuela. The data used are collected from a database of Johns Hopkins University, an institution that is dedicated to sensing and monitoring the evolution of the COVID-19 pandemic. A statistical analysis, based on principal components with modern and recent techniques, is conducted. Initially, utilizing the correlation matrix, standard components and varimax rotations are calculated. Then, by using disjoint components and functional components, the countries are grouped. An algorithm that allows us to keep the principal component analysis updated with a sensor in the data warehouse is designed. As reported in the conclusions, this grouping changes depending on the number of components considered, the type of principal component (standard, disjoint or functional) and the variable to be considered (infected cases or deaths). The results obtained are compared to the k-means technique. The COVID-19 cases and their deaths vary in the different countries due to diverse reasons, as reported in the conclusions.

The Chronicle of COVID-19 and Possible Strategies to Curb the Pandemic

COVID-19, a type of infection that emerged in Wuhan, has become a pandemic affecting people worldwide and is rapidly spreading and evolving. Day by day, the confirmed cases and deaths are increasing many folds. SARS-CoV-2 is a novel virus; therefore, limited data are available to curb the disease. Epidemiological approaches, such as isolation, quarantine, social distancing, lockdown, and curfew, are being employed to halt the spread of the disease. Individual and joint efforts all over the world are producing a wealth of data and information which are expected to produce therapeutic strategies against COVID-19. Current research focuses on the utilization of antiviral drugs, repurposing strategies, vaccine development, as well as basic to advanced research about the organism and the infection. The review focuses on its life cycle, targets, and possible therapeutic strategies, which can lead to further research and development of COVID-19 therapy.

Expression of ACE2, Soluble ACE2, Angiotensin I, Angiotensin II and Angiotensin-(1-7) Is Modulated in COVID-19 Patients

The etiological agent of COVID-19 SARS-CoV-2, is primarily a pulmonary-tropic coronavirus. Infection of alveolar pneumocytes by SARS-CoV-2 requires virus binding to the angiotensin I converting enzyme 2 (ACE2) monocarboxypeptidase. ACE2, present on the surface of many cell types, is known to be a regulator of blood pressure homeostasis through its ability to catalyze the proteolysis of Angiotensin II (Ang II) into Angiotensin-(1-7) [Ang-(1-7)]. We therefore hypothesized that SARS-CoV-2 could trigger variations of ACE2 expression and Ang II plasma concentration in SARS-CoV-2-infected patients. We report here, that circulating blood cells from COVID-19 patients express less ACE2 mRNA than cells from healthy volunteers. At the level of circulating cells, this ACE2 gene dysregulation mainly affects the monocytes, which also show a lower expression of membrane ACE2 protein. Moreover, soluble ACE2 (sACE2) plasma concentrations are lower in prolonged viral shedders than in healthy controls, while the concentration of sACE2 returns to normal levels in short viral shedders. In the plasma of prolonged viral shedders, we also found higher concentrations of Ang II and angiotensin I (Ang I). On the other hand, the plasma levels of Ang-(1-7) remains almost stable in prolonged viral shedders but seems insufficient to prevent the adverse effects of Ang II accumulation. Altogether, these data evidence that the SARS-CoV-2 may affect the expression of blood pressure regulators with possible harmful consequences on COVID-19 outcome.

The secondary transmission pattern of COVID-19 based on contact tracing in Rwanda

Introduction

COVID-19 has shown an exceptionally high spread rate across and within countries worldwide. Understanding the dynamics of such an infectious disease transmission is critical for devising strategies to control its spread. In particular, Rwanda was one of the African countries that started COVID-19 preparedness early in January 2020, and a total lockdown was imposed when the country had only 18 COVID-19 confirmed cases known. Using intensive contact tracing, several infections were identified, with the majority of them being returning travellers and their close contacts. We used the contact tracing data in Rwanda for understanding the geographic patterns of COVID-19 to inform targeted interventions.

Methods

We estimated the attack rates and identified risk factors associated to COVID-19 spread. We used Bayesian disease mapping models to assess the spatial pattern of COVID-19 and to identify areas characterised by unusually high or low relative risk. In addition, we used multiple variable conditional logistic regression to assess the impact of the risk factors.

Results

The results showed that COVID-19 cases in Rwanda are localised mainly in the central regions and in the southwest of Rwanda and that some clusters occurred in the northeast of Rwanda. Relationship to the index case, being male and coworkers are the important risk factors for COVID-19 transmission in Rwanda.

Conclusion

The analysis of contact tracing data using spatial modelling allowed us to identify high-risk areas at subnational level in Rwanda. Estimating risk factors for infection with SARS-CoV-2 is vital in identifying the clusters in low spread of SARS-CoV-2 subnational level. It is imperative to understand the interactions between the index case and contacts to identify superspreaders, risk factors and high-risk places. The findings recommend that self-isolation at home in Rwanda should be reviewed to limit secondary cases from the same households and spatiotemporal analysis should be introduced in routine monitoring of COVID-19 in Rwanda for policy making decision on real time.

Sentiment Analysis Techniques Applied to Raw-Text Data from a Csq-8 Questionnaire about Mindfulness in Times of COVID-19 to Improve Strategy Generation

The use of artificial intelligence in health care has grown quickly. In this sense, we present our work related to the application of Natural Language Processing techniques, as a tool to analyze the sentiment perception of users who answered two questions from the CSQ-8 questionnaires with raw Spanish free-text. Their responses are related to mindfulness, which is a novel technique used to control stress and anxiety caused by different factors in daily life. As such, we proposed an online course where this method was applied in order to improve the quality of life of health care professionals in COVID 19 pandemic times. We also carried out an evaluation of the satisfaction level of the participants involved, with a view to establishing strategies to improve future experiences. To automatically perform this task, we used Natural Language Processing (NLP) models such as swivel embedding, neural networks, and transfer learning, so as to classify the inputs into the following three categories: negative, neutral, and positive. Due to the limited amount of data available-86 registers for the first and 68 for the second-transfer learning techniques were required. The length of the text had no limit from the user's standpoint, and our approach attained a maximum accuracy of 93.02% and 90.53%, respectively, based on ground truth labeled by three experts. Finally, we proposed a complementary analysis, using computer graphic text representation based on word frequency, to help researchers identify relevant information about the opinions with an objective approach to sentiment. The main conclusion drawn from this work is that the application of NLP techniques in small amounts of data using transfer learning is able to obtain enough accuracy in sentiment analysis and text classification stages.

Implemented Interventions at the Naef K. Basile Cancer Institute to Protect Patients and Medical Personnel From COVID Infections: Effectiveness and Patient Satisfaction

Background

The Coronavirus Disease 2019 (COVID-19) was declared a pandemic by WHO in March 2020. The first case of COVID-19 was identified in Lebanon on the 21^st of February 2020, amid a national economic crisis. As the numbers of cases increased, ICU admissions and mortality rose, which led hospitals across Lebanon to take certain safety measures to contain the virus. The Naef K. Basile Cancer Institute (NKBCI) at the American University of Beirut Medical Center handles oncology outpatient visits and outpatient treatment protocol infusions. The aim of this study is to evaluate the efficacy of the safety measures put forth by the NKBCI early in the pandemic.

Methods

Oncology patients are amongst the immunosuppressed population, who are at greatest risk of contracting COVID-19 and consequently suffering its complications. In this manuscript, we evaluated the precautionary measures implemented at the NKBCI of AUBMC from March 1^st to May 31^st of 2020, by surveying oncology patients on the telephone who had live and virtual appointments in both the oncology outpatient clinics and infusion unit. We conducted a prospective study of 670 oncology patients who had appointments at the NKBCI during this period and used their answers to draw responses about patient satisfaction towards those safety measures.

Results

Our results involved 387 responses of oncology patients who visited the NKBCI during the period of March 1^st to May 31^st of 2020. 99% of our respondents gave a rating of good to excellent with these new measures. The option of online consultation was given to 35% in the hematology group compared to 19% in those with solid tumors (p=0.001). From the total, 15% of patients opted for the telemedicine experience as a new implemented strategy to provide patient-centered medical care. Of this group of patients, 22% faced problems with connectivity and 19% faced problems with online payment.

Conclusion

NKBCI was competent in following the WHO guidelines in protecting the oncology patient population. Feedback collected from the surveys will be taken into account by the committee of the NKBCI to develop new safety measures that can better control viral spread while providing patient-centered medical care.

Reductions in mortality resulting from COVID-19 quarantine measures in China

Background

To explore the impact of quarantine measures on the cause of death.

Methods

We use time series analysis with the data from death cause surveillance database of Suzhou from January 2017 to December 2019 to estimate the expected deaths from January to June 2020 and compare these expected deaths with the reported numbers of deaths.

Results

After the implementation of epidemic prevention measures in Suzhou in the first 3 months, overall number of all-cause deaths declined for 5.36, 7.54 and 7.02% compared with predicted numbers. The number of deaths from respiratory causes and traffic accidents declined shapely by 30.1 and 26.9%, totally. When quarantine measures were released (April–June), however, the observed numbers of total deaths exceeded the predicted deaths. People aged over 70 accounted for 91.6% of declined death number in respiratory causes and people aged over 60 accounted for 68.0% of declined death number in traffic accidents. Women over the age of 80 benefited the most from respiratory prevention (accounts for 41% of all reductions), whereas women aged over 60 benefited the most from traffic control (44%).

Conclusions

Overall, the whole population benefited from the epidemic prevention measures especially elderly females. This study is a useful supplement to encourage the government to develop regular preventive measures under the era of normalized epidemic.

Therapeutic Potential of Glycosyl Flavonoids as Anti-Coronaviral Agents

The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread all over the world, creating a devastating socio-economic impact. Even though protective vaccines are starting to be administered, an effective antiviral agent for the prevention and treatment of COVID-19 is not available yet. Moreover, since new and deadly CoVs can emerge at any time with the potential of becoming pandemics, the development of therapeutic agents against potentially deadly CoVs is a research area of much current interest. In the search for anti-coronaviral drugs, researchers soon turned their heads towards glycosylated flavonoids. Glycosyl flavonoids, widespread in the plant kingdom, have received a lot of attention due to their widely recognized antioxidant, anti-inflammatory, neuroprotective, anticarcinogenic, antidiabetic, antimicrobial, and antiviral properties together with their capacity to modulate key cellular functions. The wide range of biological activities displayed by glycosyl flavonoids, along with their low toxicity, make them ideal candidates for drug development. In this review, we examine and discuss the up-to-date developments on glycosyl flavonoids as evidence-based natural sources of antivirals against coronaviruses and their potential role in the management of COVID-19.

Readability, content, and quality of COVID-19 patient education materials from academic medical centers in the United States

Background

SARS-CoV-2 has spread rapidly resulted in a global pandemic and public health crisis. The internet is a frequently used resource for providing patient education materials (PEMs). The aim of this study was to evaluate the readability, content, and quality of web-based PEMs on COVID-19 from US academic medical centers.

Methods

The names of US medical schools were obtained from the Association of American Medical Colleges website (n = 145). Institutional, hospital, and heath encyclopedia websites associated with each schools’ medical center were identified using Google. Readability of COVID-19 PEMs was calculated using three validated indices: (1) Flesh-Kincaid Grade Level, (2) Simple Measure of Gobbledygook, and (3) Gunning Frequency of Gobbledygook. Content was evaluated using a scoring matrix based on materials available on the Center for Disease Control website. The Patient Education Material Assessment Tool for Print (PEMAT-P) was used to assess usability and actionability.

Results

A total of 141 (97%) PEMs met inclusion criteria and were analyzed for readability, content, and quality. The mean readability was above the recommended sixth grade reading level (P < .001). Content was variable across PEMs. The PEMAT-P scores reflected good understandability with a median score of 83% (IQR 75%-87%), while actionability was poor with a median score of 41% (IQR 40%-60%).

Conclusions

Despite availability of web-based PEMs for COVID-19, the readability was significantly higher than the National Institute of Health and US Department of Health and Human Services recommended sixth grade reading level and actionability of PEMs was low. It is critical to provide readable PEMs on COVID-19 to effectively disseminate accurate information and facilitate patients’ understanding of the virus, how it spreads, and how to protect themselves.

Bioaerosols in orthopedic surgical procedures and implications for clinical practice in the times of COVID-19: A systematic review and meta-analysis

INTRODUCTION

Orthopedic surgical procedures (OSPs) are known to generate bioaerosols, which could result in transmission of infectious diseases. Hence, this review was undertaken to analyse the available evidence on bioaerosols in OSPs, and their significance in COVID-19 transmission.

METHODS

A systematic review was conducted by searching the PubMed, EMBASE, Scopus, Cochrane Library, medRxiv, bioRxiv and Lancet preprint databases for studies on bioaerosols in OSPs. Random-effects metanalysis was conducted to determine pooled estimates of key bioaerosol characteristics. Risk of bias was assessed by the RoB-SPEO tool; overall strength of evidence was assessed by the GRADE approach.

RESULTS

17 studies were included in the systematic review, and 6 in different sets of meta-analyses. The pooled estimate of particle density was 390.74 μg/m3, Total Particle Count, 6.08 × 106/m3, and Microbial Air Contamination, 8.08 CFU/m3. Small sized particles (

CONCLUSION

Whereas there is evidence to suggest that OSPs generate large amounts of bioaerosols, their potential to transmit infectious diseases like COVID-19 is questionable. High-quality research, as well as consensus minimum reporting guidelines for bioaerosol research in OSPs is the need of the hour.

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Key Words

• Aerosol
• Aerosol generating procedure (AGP)
• COVID19
• Coronavirus
• Guideline
• Orthopaedics surgical procedures
• Personal protective equipment (PPE)
• Review
• SARS

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Affiliation(s)

Siddhartha Sharma Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
Rakesh John Department of Orthopaedics, Hull and Yorkshire Royal Infirmary, Hull, United Kingdom
Sandeep Patel Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
Deepak Neradi Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
Kamal Kishore Department of Biostatistics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
Mandeep S. Dhillon Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India

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SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS-2 (SARS-COV-2) INFECTION: AN EPIDEMIOLOGICAL REVIEW

BACKGROUND

New strains of different organisms, three of which has been caused by betacorona viruses (SARS-CoV, MERS-CoV and SARSCoV- 2) have caused epidemics and pandemics. The COVID-19, caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) started in China in December 2019 has spread globally. Understanding its pattern of spread and how it affects the populace helps to guide formulation of strategies at curbing its spread, managing the disease and allocation of limited resources in tackling the pandemic.

METHODOLOGY

This is a review article about the epidemiology of the coronavirus disease -2019 (COVID-19). Various search engines were used to accumulate literature on the topic; these include PubMed, Google scholar, Ajol.

RESULTS

As at October 29, 2020, SARS-CoV2 has spread to all continents except the Antarctica. Though a zoonotic disease, human to human transmission has resulted to this pandemic is via direct and indirect contact of droplets with mucosal surfaces. Most severe cases occur among the elderly, males, and people with co-morbid diseases. The average incubation period is 2-10 days. When compared with SARS-CoV (Ro: 2.3-3.7, mortality rate 11%) and MERS-CoV (Ro: 0.8-1.3, mortality rate: 34.3%), SARS-Cov-2 is a highly infective (Ro: as high as 6.5) with low mortality rates (average range mortality rates 1.83- 6.3%).

CONCLUSION

COVID-19 is a highly infective novel virus. Older persons and people with medical comorbidities are more susceptible to the severe form of the disease and mortality. As the second wave comes on, a sustainable measure of limiting the spread and consequences of COVID-19 should be more emphasized.

Case fatality rate of COVID-19: a systematic review and meta-analysis

OBJECTIVE

The ongoing novel coronavirus disease 2019 (COVID-19) is the leading cause of morbidity and mortality due to its contagious nature and absence of vaccine and treatment. Although numerous primary studies reported extremely variable case fatality rate (CFR) of COVID-19, no review study attempted to estimate the CFR of COVID-19. The current systematic review and meta-analysis were aimed to assess the pooled CFR of COVID-19.

METHODS

Electronic databases: PubMed, Science Direct, Scopus, and Google Scholar were searched to retrieve the eligible primary studies that reported CFR of COVID-19. Keywords: ("COVID-19"OR "COVID-2019" OR "severe acute respiratory syndrome coronavirus 2"OR "severe acute respiratory syndrome coronavirus 2" OR "2019-nCoV" OR "SARS-CoV-2" OR "2019nCoV" OR (("Wuhan" AND ("coronavirus" OR "coronavirus")) AND (2019/12[PDAT] OR 2020[PDAT]))) AND ("mortality "OR "mortality" OR ("case" AND "fatality" AND "rate") OR "case fatality rate") were used as free text and MeSH term in searching process. A random-effects model was used to estimate the CFR in this study. I2 statistics, Cochran's Q test, and T2 were used to assess the functional heterogeneity between included studies.

RESULTS

The overall pooled CFR of COVID 19 was 10.0%(95% CI: 8.0-11.0); P < 0.001; I2 = 99.7). The pooled CFR of COVID-19 in general population was 1.0% (95% CI: 1.0-3.0); P < 0.001; I2 = 94.3), while in hospitalized patients was 13.0% (95% CI: 9.0-17.0); P < 0.001, I2 = 95.6). The pooled CFR in patients admitted in intensive care unit (ICU) was 37.0% (95% CI: 24.0-51.0); P < 0.001, I2 = 97.8) and in patients older than 50 years was 19.0% (95% CI: 13.0-24.0); P < 0.001; I2 = 99.8).

CONCLUSION

The present review results highlighted the need for transparency in testing and reporting policies and denominators used in CFR estimation. It is also necessary to report the case's age, sex, and the comorbidity distribution of all patients, which essential in comparing the CFR among different segments of the population.

Multifaced Roles of HDL in Sepsis and SARS-CoV-2 Infection: Renal Implications

High-density lipoproteins (HDLs) are a class of blood particles, principally involved in mediating reverse cholesterol transport from peripheral tissue to liver. Omics approaches have identified crucial mediators in the HDL proteomic and lipidomic profile, which are involved in distinct pleiotropic functions. Besides their role as cholesterol transporter, HDLs display anti-inflammatory, anti-apoptotic, anti-thrombotic, and anti-infection properties. Experimental and clinical studies have unveiled significant changes in both HDL serum amount and composition that lead to dysregulated host immune response and endothelial dysfunction in the course of sepsis. Most SARS-Coronavirus-2-infected patients admitted to the intensive care unit showed common features of sepsis disease, such as the overwhelmed systemic inflammatory response and the alterations in serum lipid profile. Despite relevant advances, episodes of mild to moderate acute kidney injury (AKI), occurring during systemic inflammatory diseases, are associated with long-term complications, and high risk of mortality. The multi-faceted relationship of kidney dysfunction with dyslipidemia and inflammation encourages to deepen the clarification of the mechanisms connecting these elements. This review analyzes the multifaced roles of HDL in inflammatory diseases, the renal involvement in lipid metabolism, and the novel potential HDL-based therapies.

Impact of COVID-19 on aortic operations

The coronavirus disease 2019 (COVID-19) outbreak has profoundly affected all aspects of medicine and surgery. Vascular surgery practice and interventions were also forced to change in order to deal with new COVID-19-related priorities and emergencies. In this setting, difficulties in aortic disease management were two-fold: new vascular complications related to COVID-19 infection and the need to guarantee prompt and correct treatment for the general "non-COVID-19" population. Furthermore, discomfort deriving from precautions to minimize the risk of virus transmission among patients and among health care professionals, the need to separate COVID-19-positive from COVID-19-negative patients, and the high incidence of postoperative complications in COVID-19 cases created a challenging scenario for cardiac operations. The aim of this review was to provide evidence derived from the published literature (case reports, case series, multicenter experience, and expert opinion) on the impact of the COVID-19 outbreak on aortic vascular surgery services and interventions, describing COVID-19-related findings, intraoperative and postoperative outcomes, as well as the impact of the COVID-19 outbreak on noninfectious aortic patients.

Recent updates in COVID-19 with emphasis on inhalation therapeutics: Nanostructured and targeting systems

The current world health threat posed by the novel coronavirus disease of 2019 (COVID-19) calls for the urgent development of effective therapeutic options. COVID-19 needs daunting routes such as nano-antivirals. Hence, the role of nanotechnology is very critical in combating this nano-enemy "virus." Although substantial resources are under ongoing attention for prevention and care, we would like to start sharing with readers our vision of the role of inhaled nanomaterials and targeting systems that can play an important role in the fight against the COVID-19. In this review, we underline the genomic structure of COVID-19, recent modes of virus transmission with measures to control the infection, pathogenesis, clinical presentation of SARS-CoV-2, and how much the virus affects the lung. Additionally, the recent therapeutic approaches for managing COVID-19 with emphasis on the value of nanomaterial-based technical approaches are discussed in this review. This review also focuses on the safe and efficient delivery of useable targeted therapies using designed nanocarriers. Moreover, the effectiveness and availability of active targeting of certain specific receptors expressed on the coronavirus surfaces via tailored ligand nanoparticles are manipulated. It was also highlighted in this review the role of inhaled medicines including antivirals and repurposed drugs for fighting the associated lung disorders and efficiency of developed vaccines. Moreover, the inhalation delivery safety techniques were also highlighted.

Screening of natural compounds from Cyperus rotundus Linn against SARS-CoV-2 main protease (Mpro): An integrated computational approach

Coronavirus disease 2019 (COVID-19) is a viral respiratory disease that has been spreading across the globe. The World Health Organization (WHO) declared it as a public health emergency. The treatment of COVID-19 has been hampered due to the lack of effective therapeutic efforts. Main Protease (M^pro) is a key enzyme in the viral replication cycle and its non-specificity to human protease makes it a potential drug target. Cyperus rotundus Linn, which belongs to the Cyperaceae family, is a traditional herbal medicine that has been widely studied for its antiviral properties. In this study, a computational approach was used to screen natural compounds from C. rotundus Linn using BIOVIA Discovery Suite and novel potential molecules against M^pro of SARS-CoV-2 were predicted. Molecular docking was performed using LibDock protocol and selected ligands were further subjected to docking analysis by CDOCKER. The docking scores of the selected ligands were compared with standard antiretroviral drugs such as lopinavir and ritonavir to assess their binding potentials. Interaction pharmacophore analysis was then performed for the compounds exhibiting good binding scores to evaluate their protein–ligand interactions. The selected protein–ligand complexes were subjected to molecular dynamics simulation for 50 ns. Results of binding free energy analysis revealed that two compounds—β-amyrin and stigmasta-5,22-dien-3-ol—exhibited the best binding interactions and stability. Finally, absorption, distribution, metabolism, excretion, and toxicity (ADMET) studies were performed to understand the pharmacokinetic properties and safety profile of the compounds. The overall results indicate that the phytochemicals from Cyperus rotundus Linn, namely β-amyrin and stigmasta-5,22-dien-3-ol, can be screened as potential inhibitors of SARS-CoV-2 M^pro.

Knowledge and Perceptions of COVID-19 Among Health Care Professionals, Medical Students, and Dental Students in the GCC Region: A Cross-Sectional Correlational Study

Purpose

The aim of this study was to assess the levels of awareness and knowledge regarding COVID-19 among healthcare professionals and students in Kuwait and the Gulf Cooperation Council (GCC) region.

Materials and Methods

An online cross-sectional survey using a previously validated questionnaire was used to assess the awareness and knowledge levels of COVID-19 in this study, which was distributed via various online platforms to include as many participants as possible. The study targeted medical doctors, dentists, medical students, and dental students from the GCC region. Participants were at least 18 years old, voluntarily consented to complete the questionnaire, and were assured that their responses would remain anonymous. Permission was obtained using a previously validated and applied questionnaire to assess their level of awareness and knowledge regarding COVID-19. To compare the proportional responses between groups in descriptive statistics, a proportion Z-test was used to find any significant differences, with a statistical significance set at p < 0.05.

Results

A total of 1621 participants responded to our questionnaire. Almost two-thirds of the respondents were female (64.4%), and the majority were less than 25 years old (67.2%). Dentists accounted for 12.6% of the total population, and their clinical experience ranged from 0.25 to 52 years (median: 3 years, IQR: 1–10 years). Meanwhile, medical doctors accounted for 24.5% of the responses, and their clinical experience ranged from 0 to 50 years (median: 13 years, IQR: 3–23 years). Among the dental students, 42.3% were in the pre-clinical years, while 57.7% were in the clinical years of study. However, among medical students, 57.5% were in the pre-clinical years, while 42.5% were in the clinical years of study.

Conclusion

Our results demonstrated that dental students, medical doctors, and medical students exhibited higher odds of having satisfactory COVID-19 perception scores than dentists.

The understanding of the immunopathology in COVID-19 infection

Coronaviruses belonging to the Coronaviridae family are single-stranded RNA viruses. The entry of SARS-CoV-2 is accomplished via ACE-2 receptors. SARS-CoV-2 infection coactivates both innate and adaptive immune responses. Although SARS-CoV-2 stimulates antibody production with a typical pattern of IgM/IgG, cellular immunity is also impaired. In severe cases, low CD4 + and CD8 + T cell counts are associated with impaired immune functions, and high neutrophil/lymphocyte ratios accompanying low lymphocyte subsets have been demonstrated. Recently, high IFN -α/γ ratios with impaired T cell responses, and increased IL-1, IL-6, TNF-α, MCP-1, IP-10, IL-4, IL-10 have been reported in COVID-19 infection. Increased proinflammatory cytokines and chemokines in patients with severe COVID-19 may cause the suppression of CD4 + and CD8 + T cells and regulatory T cells, causing excessive inflammatory responses and fatal cytokine storm with tissue and organ damage. Consequently, novel therapeutics to be developed against host immune system, including blockade of cytokines (IL-6, IL-1, IFN) themselves, their receptors or signaling pathways- JAK inhibitors- could be effective as potential therapeutics.

Transfer Learning to Detect COVID-19 Automatically from X-Ray Images Using Convolutional Neural Networks

The novel coronavirus disease 2019 (COVID-19) is a contagious disease that has caused thousands of deaths and infected millions worldwide. Thus, various technologies that allow for the fast detection of COVID-19 infections with high accuracy can offer healthcare professionals much-needed help. This study is aimed at evaluating the effectiveness of the state-of-the-art pretrained Convolutional Neural Networks (CNNs) on the automatic diagnosis of COVID-19 from chest X-rays (CXRs). The dataset used in the experiments consists of 1200 CXR images from individuals with COVID-19, 1345 CXR images from individuals with viral pneumonia, and 1341 CXR images from healthy individuals. In this paper, the effectiveness of artificial intelligence (AI) in the rapid and precise identification of COVID-19 from CXR images has been explored based on different pretrained deep learning algorithms and fine-tuned to maximise detection accuracy to identify the best algorithms. The results showed that deep learning with X-ray imaging is useful in collecting critical biological markers associated with COVID-19 infections. VGG16 and MobileNet obtained the highest accuracy of 98.28%. However, VGG16 outperformed all other models in COVID-19 detection with an accuracy, F1 score, precision, specificity, and sensitivity of 98.72%, 97.59%, 96.43%, 98.70%, and 98.78%, respectively. The outstanding performance of these pretrained models can significantly improve the speed and accuracy of COVID-19 diagnosis. However, a larger dataset of COVID-19 X-ray images is required for a more accurate and reliable identification of COVID-19 infections when using deep transfer learning. This would be extremely beneficial in this pandemic when the disease burden and the need for preventive measures are in conflict with the currently available resources.

Electrospinning fabrication of polystyrene-silica hybrid fibrous membrane for high-efficiency air filtration

The development of new materials for air filtration and particulate matter (PM) pollution is critical to solving global environmental issues that threaten human health and accelerate the greenhouse effect. In this study, a novel electrospun polystyrene-SiO2 nanoparticle (PS-SNP) fibrous membrane was explored by a single-step strategy to obtain the composite multi-layered filter masks. In addition, the air filtration performance of this fibrous membrane for PM was evaluated. The effects of SiO2 on the composition, morphology, mechanical property, and surface wetting of PS-SNP membranes were studied. Allowing SiO2 to be incorporated into the PS polymer was endowed with promising superhydrophobicity and demonstrated excellent mechanical properties. As-prepared PS-SNP membranes possess significantly better filtration efficiency than pure PS membrane. Furthermore, a three-layered air filter media (viscose/PS-SNP/polyethylene terephthalate) used in this study has considerable performances compared to the commercial masks. Since this air filtration membrane has excellent features such as high air filtration and permeability, we anticipate it to have huge potential application in air filtration systems, including cleanroom, respirator, and protective clothing.

Primary health care and social isolation against COVID-19 in Northeastern Brazil: Ecological time-series study

BACKGROUND

Brazil is witnessing a massive increase of corona virus disease (COVID-19). Its peculiar primary health care (PHC) system faces a burden due to the contagion occurring in the community environment. Then, the aim is to estimate the effect of the coverage of primary health care and social isolation on the evolution of confirmed cases and deaths by COVID-19, controlling sociodemographic, economic and health system aspects.

METHODS

A time series design was designed with data on diagnosed cases of COVID-19 and their deaths as outcomes in the capital cities of the Northeast region of Brazil. Independent variables such as PHC coverage, hospital beds, social isolation, demographic density, Gini index and other indicators were analyzed. A Autoregressive Generalized Linear Model method was applied for model the relationship.

RESULTS

We identified an exponential growth of cases (y = 0.00250.71x; p-value<0,001). However, there is a high variability in the occurrence of outcomes. PHC coverage≥75% (χ2 = 9.27; p-value = 0.01) and social isolation rate (χ2 = 365.99; p-value<0.001) proved to be mitigating factors for the spread of COVID-19 and its deaths. Capitals with hospital beds ≥ 3.2 per thousand inhabitants had fewer deaths (χ2 = 9.02; p-value = 0.003), but this was influenced by PHC coverage (χ2 = 30,87; p-value<0.001).

CONCLUSIONS

PHC mitigates the occurrence of Covid-19 and its deaths in a region of social vulnerability in Brazil together with social isolation. However, it is not known until when the system will withstand the overload in view of the low adhesion to social isolation, the lack of support and appropriate direction from the government to its population.

Scalable, Micro-Neutralization Assay for Assessment of SARS-CoV-2 (COVID-19) Virus-Neutralizing Antibodies in Human Clinical Samples

As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic expanded, it was clear that effective testing for the presence of neutralizing antibodies in the blood of convalescent patients would be critical for development of plasma-based therapeutic approaches. To address the need for a high-quality neutralization assay against SARS-CoV-2, a previously established fluorescence reduction neutralization assay (FRNA) against Middle East respiratory syndrome coronavirus (MERS-CoV) was modified and optimized. The SARS-CoV-2 FRNA provides a quantitative assessment of a large number of infected cells through use of a high-content imaging system. Because of this approach, and the fact that it does not involve subjective interpretation, this assay is more efficient and more accurate than other neutralization assays. In addition, the ability to set robust acceptance criteria for individual plates and specific test wells provided further rigor to this assay. Such agile adaptability avails use with multiple virus variants. By February 2021, the SARS-CoV-2 FRNA had been used to screen over 5000 samples, including acute and convalescent plasma or serum samples and therapeutic antibody treatments, for SARS-CoV-2 neutralizing titers.

Technique for analyzing the transfer of colored cosmetics onto face masks

BACKGROUND

With the rapid spread of COVID-19, the makeup trend in the cosmetics market is changing as mask-wearing has become a common practice. This study was conducted to establish an objective and reliable method for analyzing the transfer of colored cosmetics onto face masks.

METHODS

A total of 24 women participated in this test. The participants were requested to wear Korean Filter 94 masks after having applied colored cosmetics on their faces and lips. VISIA-CR was used to photograph the face, and a camera was used to photograph the mask, which had smeared the cosmetics. Each image was analyzed using the Image-pro^® 10 image analysis software.

RESULTS

Immediately after applying the cosmetics, the intensity of the face decreased and the redness of the lips increased when compared with the results 30 minutes after washing the face. After wearing a mask, the intensity increased and the redness decreased when compared with immediately after applying the cosmetics. The area before and after the colored cosmetics smeared onto the mask was increased.

CONCLUSION

It is expected that this study could be used as a reference for further experiments on analysis of methods for preventing mask stains.

Mathematical modelling for decision making of lockdown during COVID-19

Due to the recent worldwide outbreak of COVID-19, there has been an enormous change in our lifestyle and it has a severe impact in different fields like finance, education, business, travel, tourism, economy, etc., in all the affected countries. In this scenario, people must be careful and cautious about the symptoms and should act accordingly. Accurate predictions of different factors, like the end date of the pandemic, duration of lockdown and spreading trend can guide us through the pandemic and precautions can be taken accordingly. Multiple attempts have been made to model the virus transmission, but none of them has investigated it at a global level. The novelty of the proposed work lies here. In this paper, first, authors have analysed spreading of the said disease using data collected from various platforms and then, have presented a predictive mathematical model for fifteen countries from first, second and third world for probable future projections of this pandemic. The prediction can be used by planning commission, healthcare organizations and the government agencies as well for creating suitable arrangements against this pandemic.

Mesenchymal Stem Cells and COVID-19: Cure, Prevention, and Vaccination

COVID-19 disease has been a global health problem since late 2019. There are many concerns about the rapid spread of this disease, and yet, there is no approved treatment for COVID-19. Several biological interventions have been under study recently to investigate efficient treatment for this viral disease. Besides, many efforts have been made to find a safe way to prevent and vaccinate people against COVID-19 disease. In severe cases, patients suffer from acute respiratory distress syndrome usually associated with an increased level of inflammatory cytokines, called a cytokine storm. It seems that reequilibrating the hyperinflammatory response of the host immune system and regeneration of damaged cells could be the main way to manage the disease. Mesenchymal stem cells (MSCs) have been recently under investigation in this regard, and the achieved clinical outcomes show promising evidence for stem cell-based therapy of COVID-19. MSCs are known for their potential for immunomodulation, defense against virus infection, and tissue regeneration. MSCs are a newly emerged platform for designing vaccines and show promising evidence in this area. In the present study, we provided a thorough research study on the most recent clinical studies based on stem cells in the treatment of COVID-19 while introducing stem cell exclusivities for use as an immune disorder or lung cell therapy and its potential application for protection and vaccination against COVID-19.

Telemedicine usage via WeChat for children with congenital heart disease preoperatively during COVID-19 pandemic: a retrospective analysis

Objective

During the COVID-19 pandemic, parents of infants having medical problem face challenges of insufficient medical resources at home. The purpose of this study was to investigate the effect of WeChat-based telehealth services on the preoperative follow-up of infants with congenital heart disease (CHD) during the COVID-19 pandemic.

Methods

This study retrospectively analyzed the medical records of 190 infants with CHD who underwent remote follow-up via WeChat from December 2019 to May 2020 in Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University. In addition, the psychological benefits of WeChat on the parents of these infants were analyzed.

Results

In total, 190 infants were involved in this study, including 72 cases of ventricular septal defects, 42 cases of patent ductus arteriosus, 55 cases of atrial septal defects, 3 cases of tetralogy of Fallot, 2 cases of endocardial cushion defects, 12 cases of pulmonary stenosis, 2 cases of total anomalous pulmonary venous connection and 2 cases of aortic arch constriction. During the follow-up period, 48 infants who received surgical indications were hospitalized in time for surgical treatment. It was recommended that 10 infants with respiratory tract infections be treated in local hospitals through the WeChat platform. We provided feeding guidance to 28 infants with dysplasia through the WeChat platform. The psychological evaluation results of parents showed that the median score and range of Self-Rating Depression Scale scores were 42 and 32–58, respectively. Nine parents (4.7%) were clinically depressed, while the majority had mild depression. The median score and range of Self-Rating Anxiety Scale scores were 44 and 31–59, respectively. Twenty parents (10.5%) had clinical anxiety, while the rest had mild anxiety.

Conclusion

During the COVID-19 pandemic, follow-up management and health services for infants with CHD prior to surgery through the WeChat platform were useful in identifying the state of an infant’s condition as well as in identifying and relieving care pressure, anxiety and depression in the parents.

Financial Decisions and Reopening a Practice During the COVID-19 Pandemic: A Survey of California Plastic Surgeons

BACKGROUND

On March 11, 2020, the World Health Organization declared COVID-19 as a global pandemic. As a response, the United States shut down public gatherings and businesses in an effort to quarantine. This included the stopping of elective operations, which greatly affected plastic surgeons and their practices during the initial shutdown.

OBJECTIVES

We aim to study the early impact of COVID-19 on the financial implications and practice patterns of plastic surgeons in the state of California during the initial shutdown of elective surgery and provide guidelines for effective management during future crises.

METHODS

A 20-question survey was sent using Qualtrics XM software to 851 surgeon members of the California Society of Plastic Surgeons. The survey was open from May 13, 2020, to May 29, 2020. Standard statistical analysis was completed to compare private practice and nonprivate practice plastic surgeons.

RESULTS

We had a total of 140 respondents to our survey for a 16.5% response rate. The majority (77.1%) of the respondents were in a private practice setting. Private practice plastic surgeons reported a higher financial impact with a 79% reduction in financial income compared with nonprivate practice plastic surgeons at a 37% reduction (P < 0.0001). Additionally, private practice plastic surgeons demonstrated a higher reduction in case volume and were more likely to lay off or furlough staff, close their practice, and apply for loans (P < 0.001).

CONCLUSIONS

Our survey study showed that private practice plastic surgeons in the state of California faced the most financial hardship during the early shutdown of the COVID-19 pandemic. It serves as a valuable snapshot in our economic history and depicts the heavy financial impact of the stopping of elective surgery. Since the reopening of practices, new guidelines have been implemented to maintain safe elective surgery while the pandemic continues. Further follow-up studies on both the state and national level need to be completed to see the continued financial effects on private and nonprivate plastic surgery practices since the reopening and resumption of elective surgery.

Phylo-geo-network and haplogroup analysis of 611 novel coronavirus (SARS-CoV-2) genomes from India

The novel coronavirus (SARS-CoV-2) from Wuhan China discovered in December 2019 has since developed into a global epidemic. Presently, we constructed and analyzed the phylo-geo-network of SARS-CoV-2 genomes from across India to understand the viral evolution in the country. A total of 611 full-length genomes from different states of India were extracted from the EpiCov repository of GISAID initiative on 6 June, 2020. Their alignment with the reference sequence (Wuhan, NCBI accession number NC_045512.2) uncovered 270 parsimony informative sites. Furthermore, 339 genomes were divided into 51 haplogroups. The network revealed the core haplogroup as that of reference sequence NC_045512.2 (Haplogroup A1) with 157 identical sequences present across 16 states. Remaining haplogroups had <10 identical sequences across a maximum of three states. Some states with fewer samples had more haplogroups. Forty-one haplogroups were localized exclusively to any one state. The two most common lineages are B6 and B1 (Pangolin) whereas clade A2a (Covidex) appears to be the most predominant in India. Because the pandemic is still emerging, the observations need to be monitored.

Exploring the treatment of COVID-19 with Yinqiao powder based on network pharmacology

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In China, Yinqiao powder is widely used to prevent and treat COVID-19 patients with Weifen syndrome. In this study, the screening and verification of active ingredients, target selection and DisGeNET scoring, drug-ingredient-gene network construction, protein-protein interaction network construction, molecular docking and surface plasmon resonance (SPR) analysis, gene ontology (GO) functional analysis, gene tissue analysis, and kyoto encyclopedia of genes and genomes (KEGG) pathway analysis were used to explore the active ingredients, targets, and potential mechanisms of Yinqiao powder in the treatment of COVID-19. We also predicted the therapeutic effect of Yinqiao powder using TCM anti-COVID-19 (TCMATCOV). Yinqiao powder has a certain therapeutic effect on COVID-19, with an intervention score of 20.16. Hesperetin, eriodictyol, luteolin, quercetin, and naringenin were the potentially effective active ingredients against COVID-19. The hub-proteins were interleukin-6 (IL-6), mitogen-activated protein kinase 3 (MAPK3), tumor necrosis factor (TNF), and tumor protein P53 (TP53). The potential mechanisms of Yinqiao powder in the treatment of COVID-19 are the TNF signaling pathway, T-cell receptor signaling pathway, Toll-like receptor signaling pathway, and MAPK signaling pathway. This study provides a new perspective for discovering potential drugs and mechanisms of COVID-19.

Acute inflammatory demyelinating polyneuropathy or Guillain-Barré syndrome associated with COVID-19: a case report

Background

Coronavirus disease 2019 (COVID-19) is a global pandemic. The disease, typically characterized by bilateral pulmonary infiltrates and profound elevation of inflammatory markers, can range in severity from mild or asymptomatic illness to a lethal cytokine storm and respiratory failure. A number of recognized complications of COVID-19 infection are described in the literature. Common neurological complications include headache and anosmia. Guillain-Barré syndrome (GBS) is an uncommon complication described in isolated case reports. However, a causal relationship has yet to be established. This case report adds to the growing body of evidence that GBS is a potential COVID-19 complication.

Case presentation

A 70-year-old Caucasian woman with recently diagnosed COVID-19 infection presented to the emergency department with 4 days of gradually worsening ascending lower extremity weakness. Exam revealed bilateral lower extremity weakness, mute reflexes, and sensory loss. Soon after starting intravenous administration of immunoglobulin (IVIG), the patient developed respiratory distress, eventually requiring intubation. She remained intubated for the duration of her IVIG treatment. After five rounds of treatment, the patient was successfully extubated and transferred to acute rehab. Following 4 weeks of intense physical therapy, she was able to walk with assistance on room air.

Conclusion

At the present time, this is one of the few reports of acute inflammatory demyelinating polyneuropathy (AIDP) or GBS associated with COVID-19 in the United States. It is unclear whether a causal relationship exists given the nature of the syndrome. However, in light of the growing number of reported cases, physicians should be aware of this possible complication when evaluating COVID-19 patients.