Review of the Clinical Characteristics of Coronavirus Disease 2019 (COVID-19)

Clinical Symptoms of COVID-19 and Their Association with Disease Outcome

BACKGROUND

COVID-19 pandemic placed immense pressure on health systems. The current study aimed to evaluate the symptoms of COVID-19 in Isfahan province and their association with disease outcome.

MATERIALS AND METHODS

In this cross-sectional study, which was conducted on patients with a definite diagnosis of COVID-19, as a part of the investigations performed by the Deputy for Public Health of the Isfahan University of Medical Sciences, the frequency of underlying diseases, and general, respiratory, gastrointestinal, neurological, renal, cardiac, dermal, hearing symptoms are assessed using a checklist. The participants were followed up 1 month after definitive diagnosis, and the outcome of the disease (recovery or death) was recorded.

RESULTS

Of 300 patients, 143 (47.4%) were male and 157 (52.6%) were female. The mean age of patients was 43 ± 17.84 years. Muscle pain and fatigue were the most common early symptoms (63% and 60.3%, respectively). Age, sex, level of education, and occupation of patients and general, respiratory, and gastrointestinal symptoms and underlying diseases of respiratory disease showed a statistically significant association with the disease outcome (P < 0.05).

CONCLUSION

General, respiratory, and gastrointestinal symptoms were associated with an increased risk of death due to COVID-19. General, visual, and hearing symptoms, and diabetes, cardiovascular diseases, and respiratory disease had a statistically significant association with the hospitalization of patients.

Knowledge and performance of the Iranian general population in the use of masks during the 2019 coronavirus

BACKGROUND

The use of personal protective equipment (especially face masks) has increased in different communities amid the COVID-19 pandemic. Therefore, the present study aimed to assess knowledge and performance of Iranian general population in wearing face masks.

MATERIALS AND METHODS

The present study is a cross-sectional study conducted using a valid and reliable questionnaire on 1843 eligible individuals. The questionnaires were shared by Link (www.porsall.com) in groups and social networks. Data were analyzed using SPSS (Version 24.0, SPSS Inc., Chicago, IL).

RESULTS

The mean age of the participants was 42.84 years (standard deviation: 16.84). The majority had inadequate and low knowledge of masks (69.2%), nearly 30% had moderate (30.1%), and few had adequate and high knowledge of masks. The individuals' knowledge on when to wear a mask was also assessed and the results showed poor and low in 42.2%, 46.9% moderate and high performance in 10.7%. The participants' performance on how to properly wear a mask was also assessed and 12% showed poor, 69.3% showed moderate, and 18.7% showed high performance. Safe removal of masks was also assessed, and the results showed 52% low and poor, 27.6% moderate, and 20.3% high performance. A significant and direct correlation was found between the overall score knowledge and performance regarding use of masks (P < 0.001).

CONCLUSION

The results showed poor to moderate knowledge and performance of majority of Iranian general population regarding the masks. Therefore, further effective training courses and action plans are needed in Iran given the importance of masks for the prevention of COVID-19, especially in public places. Educational package about how to use the mask and its benefits, through the media and health centers is recommended.

Clinical analysis of severe COVID-19 patients

BACKGROUND:

Patients with unexplained pneumonia appeared in Wuhan, Hubei Province at the end of 2019.

OBJECTIVE:

To analyze the clinical data of patients with severe COVID-19.

METHODS:

Medical records of 28 severe patients admitted to the intensive care unit of Wuhan Xinzhou District People’s Hospital were collected from January 31 to March 17.

RESULTS:

The mortality rate of severe patients in our study was 39.3%. There were statistically significant differences in age, admission systolic blood pressure, lymphocyte count, albumin, total bilirubin, and lactate dehydrogenase between the death group and the survival group (P< 0.05). There were statistically significant differences in APACHE II, CURB-65, SOFA, respiratory frequency, systolic pressure, platelet, procalcitonin, albumin, creatinine, creatine kinase isoenzyme, lactate dehydrogenase, chloride ion, prothrombin time, international normalized ratio, arterial partial pressure of oxygen, and FiO2 at ICU between the death group and the survival group (P< 0.05).

CONCLUSIONS:

Fever and cough are the main symptoms, which is useful for predicting the prognosis to dynamically measure the APACHE II, CURB-65, SOFA, respiratory frequency, lymphocyte count, platelet, lactate dehydrogenase, and coagulation tests. The drugs that protect the liver and heart may improve the survival rate of patients with severe COVID-19.

The mechanism of multiple organ dyfunction syndrome in patients with COVID-19

In late 2019, an outbreak of coronavirus disease 2019 (COVID‐19) arose, caused by severe acute respiratory syndrome coronavirus type 2 (SARS‐CoV‐2). This disease rapidly became a public health event of international concern. In addition to the most typical symptoms of dyspnea, numerous patients with COVID‐19 exhibited systemic symptoms, such as cardiovascular disease, liver and kidney failure, and disorders in coagulation. At present, clinical data indicates that numerous patients who are critically ill die from multiple organ dysfunction syndromes (MODS). Moreover, the entry of SARS‐CoV‐2 into cells causing severe pathology and progressive organ failure is precisely mediated by the human angiotensin‐converting enzyme 2 protein. This plays a role in maintaining both fluid and electrolyte homeostasis, ensuring the stability of the internal environment. Therefore, the present review aimed to investigate the pathogenesis of MODS caused by SARS‐CoV‐2 infection based on the current clinical data and previous studies.

Inflammatory factor storm, oxidative stress, and disseminated intravascular coagulation cause multiple organ dysfunction syndromes (MODS) in coronavirus disease 2019 patients.

Angiotensin‐converting enzyme 2 (ACE2) protein, closely related to viral infection, mediates organ damage and causes MODS.

Aging, underlying disease, and obesity downregulate ACE2 and may exacerbate MODS.

Development and evaluation of peptidomimetic compounds against SARS-CoV-2 spike protein: an in silico and in vitro study

Background: Coronavirus disease 2019 (COVID‐19) as global pandemic disease has been adversely affecting public health and social life with considerable loss of human life worldwide. Therefore, there is an urgent need for developing novel therapeutics to combat COVID‐19. The causative agent of COVID‐19 is SARS‐CoV‐2 which targets human angiotensin converting enzyme 2 (ACE2) as cellular receptor via its spike (S) protein. In this context, interfering with the binding of SARS‐CoV‐2 S protein to target molecules could provide a promising strategy to find novel therapeutic agents against SARS‐CoV‐2. The purpose of the current study was to identify potential peptidomimetics against S protein with a combination of structure‐based virtual screening methods and in vitro assays. Methods: The candidates were inspected in terms of ADME properties, drug‐likeness, as well as toxicity profiles. Additionally, molecular docking and dynamics simulations were performed to predict binding of the studied ligands to spike protein. Results: Biological evaluation of the compounds revealed that PM2 molecule exhibits some antiviral activity. Conclusion: In summary, this study highlights the importance of combining in silico and in vitro techniques in order to identify antiviral compound to tackle COVID‐19 and presents a new scaffold that may be structurally optimized for improved antiviral activity.

Complexity of the Diagnosis of COVID-19 in the Context of Pandemicity: Need for Excellence in Diagnostic Acumen

Coronavirus disease 2019 (COVID-19) is a highly infectious disease that has caused a pandemic devastating many countries worldwide. It is a complex and multifaceted disease with a unique coronavirus etiology, pathogenesis, zoonotic, and human-to-human transmission, causing acute respiratory distress syndrome with high mortality. Accurate and timely diagnosis is of utmost importance. In this study, we discussed the complexities of COVID-19 diagnostic elements in the context of pandemicity, drawing from our awareness, observations, and lessons learned from two previous coronavirus pandemics, namely SARS-CoV (severe acute respiratory syndrome coronavirus) in 2002 and MERS-CoV (Middle East respiratory syndrome-related coronavirus) in 2012, and how they applied to the diagnosis of COVID-19 today. Diagnosis of COVID-19 takes place without physician-patient personal contact due to isolation or quarantine or in the hospital setting, emergency units, and critical care units with the cumbersome barriers of personal protective equipment. Technical diagnosis is important, but we also emphasized the human impact of diagnosing COVID-19. Conveying the diagnosis of a critical disease to patients and families requires aspects of excellence in professionalism: ethics, empathy, and humility. Diagnostic skills in COVID-19 should extend to prognostication for patients suffering at the end of life, so that they will not be deprived of high-quality palliative care and comfort.

Emotion regulation in times of COVID-19: A person-centered approach based on self-determination theory

Although the COVID-19 crisis is a worldwide threat to individuals' physical health and psychological well-being, not all people are equally susceptible to increased ill-being. One potentially important factor in individuals' vulnerability (versus resilience) to ill-being in the face of stress is emotion regulation. On the basis of Self-Determination Theory, this study examined the role of three emotion regulation styles in individuals' mental health during the COVID-19 crisis, that is, integration, suppression, and dysregulation. Participants were 6584 adults (77% female, M age  = 45.16 years) who filled out well-validated measures of emotion regulation, depression, anxiety, life satisfaction, and sleep quality. To examine naturally occurring combinations of emotion regulation strategies, hierarchical k-means clustering was performed, yielding 3 profiles: (a) low scores on all strategies (indicating rather low overall levels of worry; 27%), (b) high scores on integration only (41%), and (c) high scores on suppression and dysregulation (32%). Participants in the profiles scoring high on suppression and dysregulation displayed a less favorable pattern of outcomes (high ill-being, low life satisfaction, and poorer sleep quality) compared to the other two groups. Between-cluster differences remained significant even when taking into account the corona-related worries experienced by people. Overall, the findings underscore the important role of emotion regulation in individuals' mental health during mentally challenging periods such as the COVID-19 crisis. Practical implications and directions for future research are discussed.

Intelligent Diagnosis Method for New Diseases Based on Fuzzy SVM Incremental Learning

The diagnosis of new diseases is a challenging problem. In the early stage of the emergence of new diseases, there are few case samples; this may lead to the low accuracy of intelligent diagnosis. Because of the advantages of support vector machine (SVM) in dealing with small sample problems, it is selected for the intelligent diagnosis method. The standard SVM diagnosis model updating needs to retrain all samples. It costs huge storage and calculation costs and is difficult to adapt to the changing reality. In order to solve this problem, this paper proposes a new disease diagnosis method based on Fuzzy SVM incremental learning. According to SVM theory, the support vector set and boundary sample set related to the SVM diagnosis model are extracted. Only these sample sets are considered in incremental learning to ensure the accuracy and reduce the cost of calculation and storage. To reduce the impact of noise points caused by the reduction of training samples, FSVM is used to update the diagnosis model, and the generalization is improved. The simulation results on the banana dataset show that the proposed method can improve the classification accuracy from 86.4% to 90.4%. Finally, the method is applied in COVID-19's diagnostic. The diagnostic accuracy reaches 98.2% as the traditional SVM only gets 84%. With the increase of the number of case samples, the model is updated. When the training samples increase to 400, the number of samples participating in training is only 77; the amount of calculation of the updated model is small.

Role of Probiotics in the Management of COVID-19: A Computational Perspective

Coronavirus disease 2019 (COVID-19) was declared a pandemic at the beginning of 2020, causing millions of deaths worldwide. Millions of vaccine doses have been administered worldwide; however, outbreaks continue. Probiotics are known to restore a stable gut microbiota by regulating innate and adaptive immunity within the gut, demonstrating the possibility that they may be used to combat COVID-19 because of several pieces of evidence suggesting that COVID-19 has an adverse impact on gut microbiota dysbiosis. Thus, probiotics and their metabolites with known antiviral properties may be used as an adjunctive treatment to combat COVID-19. Several clinical trials have revealed the efficacy of probiotics and their metabolites in treating patients with SARS-CoV-2. However, its molecular mechanism has not been unraveled. The availability of abundant data resources and computational methods has significantly changed research finding molecular insights between probiotics and COVID-19. This review highlights computational approaches involving microbiome-based approaches and ensemble-driven docking approaches, as well as a case study proving the effects of probiotic metabolites on SARS-CoV-2.

Neurological manifestations and pathogenic mechanisms of COVID-19

Coronavirus disease (COVID-19) arising from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral infection has caused a worldwide pandemic, mainly owing to its highly virulent nature stemming from a very strong and highly efficacious binding to the angiotensin converting enzyme-2 (ACE2) receptor. As the pandemic developed, increasing numbers of COVID-19 patients with neurological manifestations were reported, strongly suggesting a causal relationship. Indeed, direct invasion of SARS-CoV-2 viral particles into the brain can occur through the cribriform plate via olfactory nerves, passage through a damaged blood-brain-barrier, or via haematogenic infiltration of infected leukocytes. Neurological complications range from potentially fatal encephalopathy and stroke, to the onset of headaches and dizziness, which despite their apparent innocuous presentation may still imply a more sinister pathology. Here, we summarize the most recent knowledge on the neurological presentations typically being associated with COVID-19, whilst providing potential pathophysiological mechanisms. The latter are centered upon hypoxic brain injury, generation of a cytokine storm with attendant immune-mediated damage, and a prothrombotic state. A better understanding of both the neuroinvasive properties of SARS-CoV-2 and the neurological complications of COVID-19 will be important to improve patient outcomes.

COVID-19-associated meningoencephalitis in a Brazilian patient: case report and literature review

The global pandemic of COVID-19 is caused by the novel coronavirus SARS-CoV-2, which often causes flu-like symptoms and can progress to severe respiratory illness. Thus, as the disease spreads, COVID-19 cases have multiplied across the world, and manifestations involving multiple systems have been described. We report a case of COVID-19-associated meningoencephalitis in a Brazilian male patient who presented with seizures and altered mental status. To the best of our knowledge, this is the first reported case of COVID-19-associated meningoencephalitis in Brazil. COVID-19-associated meningoencephalitis is a rare manifestation of this viral infection and clinicians should be aware of this possible complication.

Hospitalization for COVID-19 is associated with a higher risk of subsequent hospitalization for psychiatric disorders: A French nationwide longitudinal study comparing hospitalizations for COVID-19 and for other reasons

Introduction

Although COVID-19 has been associated with psychiatric symptoms in patients, no study to date has examined the risk of hospitalization for psychiatric disorders after hospitalization for this disease.

Objective

We aimed to compare the proportions of hospitalizations for psychiatric disorders in the 12 months following either hospitalization for COVID-19 or hospitalization for another reason in the adult general population in France during the first wave of the current pandemic.

Methods

We conducted a retrospective longitudinal nationwide study based on the national French administrative healthcare database.

Results

Among the 2,894,088 adults hospitalized, 96,313 (3.32%) were admitted for COVID-19. The proportion of patients subsequently hospitalized for a psychiatric disorder was higher for COVID-19 patients (11.09 vs. 9.24%, OR = 1.20 95%CI 1.18–1.23). Multivariable analyses provided similar results for a psychiatric disorder of any type and for psychotic and anxiety disorders (respectively, aOR = 1.06 95%CI 1.04–1.09, aOR = 1.09 95%CI 1.02–1.17, and aOR = 1.11 95%CI 1.08–1.14). Initial hospitalization for COVID-19 in intensive care units and psychiatric history were associated with a greater risk of subsequent hospitalization for any psychiatric disorder than initial hospitalization for another reason.

Discussion

Compared with hospitalizations for other reasons, hospitalizations for COVID-19 during the first wave of the pandemic in France were associated with a higher risk of hospitalization for a psychiatric disorder during the 12 months following initial discharge. This finding should encourage clinicians to increase the monitoring and assessment of psychiatric symptoms after hospital discharge for COVID-19, and to propose post-hospital care, especially for those treated in intensive care.

Eosinophilic granulomatosis with polyangiitis after COVID-19: A case report

COVID-19 can damage the endothelial cells of every organ in the body and lead to vasculopathy and vasculitis. It has been shown that various types of vasculitis could be a new manifestation of COVID-19. Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic necrotizing vasculitis that affects small vessels. Here we report our experience with a 42-year-old man with a 3-weeks history of fever of unknown origin after two months from COVID-19 recovery presented with loss of appetite, loss of weight, and paresthesia in his lower extremities. After required evaluations including nerve biopsy, EGPA was diagnosed for him.

Pediatric asthma control during the COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

With the onset of the coronavirus disease 2019 (COVID-19) pandemic, many experts expected that asthma-associated morbidity because of severe acute respiratory syndrome coronavirus 2 infection would dramatically increase. However, some studies suggested that there was no apparent increasing in asthma-related morbidity in children with asthma, it is even possible children may have improved outcomes. To understand the relationship between the COVID-19 pandemic and asthma outcomes, we performed this article.

METHODS

We searched PubMed, Embase, and Cochrane Library to find literature from December 2019 to June 2021 related to COVID-19 and children's asthma control, among which results such as abstracts, comments, letters, reviews, and case reports were excluded. The level of asthma control during the COVID-19 pandemic was synthesized and discussed by outcomes of asthma exacerbation, emergency room visit, asthma admission, and childhood asthma control test (c-ACT).

RESULTS

A total of 22,159 subjects were included in 10 studies. Random effect model was used to account for the data. Compared with the same period before the COVID-19 pandemic, asthma exacerbation reduced (odds ratio [OR] = 0.26, 95% confidence interval [CI] = [0.14-0.48], Z = 4.32, p < 0.0001), the odds of emergency room visit decreased as well (OR = 0.11, 95% CI = [0.04-0.26], Z = 4.98, p < 0.00001). The outcome of asthma admission showed no significant difference (OR = 0.84, 95% CI = [0.32-2.20], Z = 0.36, p = 0.72). The outcome of c-ACT scores were not analyzed because of the different manifestations used. Overall, c-ACT scores reduced during the pandemic.

CONCLUSION

Compared to the same period before the COVID-19 pandemic, the level of asthma control has been significantly improved. We need to understand the exact factors leading to these improvements and find methods to sustain it.

PEROXIDATION IN THE SYNOVIAL FLUID OF PATIENTS WITH OSTEOARTHRITIS AFTER SARS-CoV 2-INFECTION

The 2019 coronavirus disease (Coronavirus disease 2019, COVID-19) poses a great threat to the health of people in all countries of the world. Infection with SARS-CoV-2 (Severe acute respiratory syndrome-related coronavirus 2) is a respiratory disease characterized by the development of severe life-threatening complications. COVID-19 is more likely to be severe and sometimes fatal, especially in older people with co-morbidities. A topical issue is predicting the course of chronic diseases in people who have contracted a coronavirus infection. An increasing number of cases of arthritis associated with COVID-19 have been reported in the literature, making this condition worthy of further study. It is known that the development of osteoarthritis is associated with oxidative stress and excessive production of reactive oxygen species. Lipid peroxidation products can serve as a marker of the intensity of free radical processes. The aim of the study was to determine the concentration of lipid peroxidation products in the synovial fluid of patients with osteoarthritis after SARS-CoV2 infection. All study participants were divided into two groups. The first group (n=22) is patients with osteoarthritis of knee joints II-III degree. The second group (n=14) is patients with osteoarthritis of the knee joints II-III degree, who suffered a mild and moderate form of COVID-19 6-9 months ago. In the conducted studies, the products of lipid peroxidation in the synovial fluid of patients of all research groups were evaluated.The content of diene conjugates was determined in the heptane-isopropanol extract by the spectrophotometric method, Schiff bases by the fluorimetric method. The content of TBA-active products was determined by the reaction with thiobarbituric acid (TBA). The processing of the research results was carried out using generally accepted methods of variational statistics. It was established that in the synovial fluid of patients with osteoarthritis of the knee joints who contracted COVID-19, the concentration of lipid peroxidation products increases compared to the group of patients with osteoarthritis (diene conjugates – by 1.7 times, TBА-active compounds – by 1,5 times, Schiff bases – 1.3 times). The detected changes indicate a violation of the oxidative-antioxidant balance. This indicates the prevalence of free radical processes and the development of oxidative stress directly in the joint. The results obtained by us indicate that patients with osteoarthritis may develop more severe joint damage and complications after infection with COVID-19.

Alcohol use disorder in the COVID-19 era: Position paper of the Italian Society on Alcohol (SIA)

Coronavirus disease 2019 (COVID-19) first emerged in China in November 2019. Most governments have responded to the COVID-19 pandemic by imposing a lockdown. Some evidence suggests that a period of isolation might have led to a spike in alcohol misuse, and in the case of patients with alcohol use disorder (AUD), social isolation can favour lapse and relapse. The aim of our position paper is to provide specialists in the alcohol addiction field, in psychopharmacology, gastroenterology and in internal medicine, with appropriate tools to better manage patients with AUD and COVID-19,considering some important topics: (a) the susceptibility of AUD patients to infection; (b) the pharmacological interaction between medications used to treat AUD and to treat COVID-19; (c) the reorganization of the Centre for Alcohol Addiction Treatment for the management of AUD patients in the COVID-19 era (group activities, telemedicine, outpatients treatment, alcohol-related liver disease and liver transplantation, collecting samples); (d) AUD and SARS-CoV-2 vaccination. Telemedicine/telehealth will undoubtedly be useful/practical tools even though it remains at an elementary level; the contribution of the family and of caregivers in the management of AUD patients will play a significant role; the multidisciplinary intervention involving experts in the treatment of AUD with specialists in the treatment of COVID-19 disease will need implementation. Thus, the COVID-19 pandemic is rapidly leading addiction specialists towards a new governance scenario of AUD, which necessarily needs an in-depth reconsideration, focusing attention on a safe approach in combination with the efficacy of treatment.

The Relationship among Splenomegaly, Lung Involvement Patterns, and Severity Score in COVID-19 Pneumonia

INTRODUCTION

The disease caused by the novel coronavirus (COVID -19) is a vital public health problem that has now affected approximately 68,037,473 people and caused 1,552,802 deaths around the world. We aimed to correlate the frequency of the lung involvement patterns, the segmental distribution of lung infiltration, and TLSS in COVID-19 pneumonia patients with and without splenomegaly.

MATERIAL AND METHODS

This retrospective study included patients admitted to Yunus Emre State Hospital Emergency, Internal Medicine and Infectious Disease Departments between March 11, 2020, and June 10, 2020, and diagnosed with COVID-19 by PCR test with a throat and nasal swab. The thoracic and upper abdomen CTs and the clinical and demographic features of the patients were analyzed at the time of initial diagnosis.

RESULTS

Consolidation (group 1 - 18 (47%), group 2 - 69 (28.2%); P = 0017), crazy pavement pattern (15 (39.5%), 42 (17.1%); p = 0.001), pleural band formations (24 (63.2%), 87 (35.5%); p = 0.001), interlobular septal thickening (23 (60.5%), 79 (32.2%); p = 0.001), and sequelae of secondary tuberculosis (4 (10.5%), 8 (3.3%); p = 0.039) were more frequent in the patient with splemomegaly. The total lung severity score was high in the group with splenomegaly (7.32 ± 6.15, 3.69 ± 5.16; p = 0.001).

CONCLUSION

Consolidation, interlobular septal thickening, tuberculosis sequela, pleural band, and crazy pavement patterns were frequent in the COVID-19 pneumonia patients with splenomegaly. The most frequently affected segment was the superior segment of the right lower lobe. TLSS was higher in the COVID-19 pneumonia patients with splenomegaly.

Protective effect of vitamin C against ivermectin induced nephrotoxicity in different age groups of male wistar rats: bio-histopathological study

Ivermectin (Ive) has exceedingly efficient against several microorganisms including viruses; therefore, it could help as a potential treatment of COVID-19. Because of increasing consumption of ivermectin and vitamin C (Vit.C) in hope to treat COVID-19, and because of ivermectin nephrotoxic effects have not been fully clarified especially in juvenile age, it was conducted to examine the histopathological and biochemical effects of ivermectin on adult and juvenile kidneys, and to assess the possible protective role of Vit.C against this potential toxicity. Rats were divided to 4 subgroups (Control subgroup, Vit.C subgroup, Ive subgroup, and Vit.C+Ive subgroup), 1 week after 4 doses of ivermectin (0.4 mg/kg Ive±1.25 mg/kg Vit.C), blood samples obtained for assessment of kidney function test, part of kidneys prepared for determination of matrix metalloproteinase-9 and antioxidant enzymes essay. Other parts prepared for histopathological and ultrastructural examination. Results showed that administration of ivermectin led to attenuation in kidney function and in activities of the antioxidant enzymes and increase in matrix metalloproteinase-9 activity. In addition, there were histological damages (shrunken glomeruli, widened urinary space, cytoplasmic vacuolation and pyknotic nuclei with epithelial exfoliation, extravasated blood, and mononuclear cell infiltration) and immunohistochemistry revealed increase in percentage of Bax proapoptotic protein expression. Also, ultrastructure examination showed alteration in cell architecture. All these changes were more obvious in juvenile group while co-administration of Vit.C led to significant protection more in adult group. In conclusion, Ivermectin should be used cautiously especially in juvenile age, and co-administration of Vit.C is highly recommended.

Comparison of prediction accuracies between mathematical models to make projections of confirmed cases during the COVID-19 pandamic by country/region

BACKGROUND

The COVID-19 pandemic caused >0.228 billion infected cases as of September 18, 2021, implying an exponential growth for infection worldwide. Many mathematical models have been proposed to predict the future cumulative number of infected cases (CNICs). Nevertheless, none compared their prediction accuracies in models. In this work, we compared mathematical models recently published in scholarly journals and designed online dashboards that present actual information about COVID-19.

METHODS

All CNICs were downloaded from GitHub. Comparison of model R2 was made in 3 models based on quadratic equation (QE), modified QE (OE-m), and item response theory (IRT) using paired-t test and analysis of variance (ANOVA). The Kano diagram was applied to display the association and the difference in model R2 on a dashboard.

RESULTS

We observed that the correlation coefficient was 0.48 (t = 9.87, n = 265) between QE and IRT models based on R2 when modeling CNICs in a short run (dated from January 1 to February 16, 2021). A significant difference in R2 was found (P < .001, F = 53.32) in mean R2 of 0.98, 0.92, and 0.84 for IRT, OE-mm, and QE, respectively. The IRT-based COVID-19 model is superior to the counterparts of QE-m and QE in model R2 particularly in a longer period of infected days (i.e., in the entire year in 2020).

CONCLUSION

An online dashboard was demonstrated to display the association and difference in prediction accuracy among predictive models. The IRT mathematical model was recommended to make projections about the evolution of CNICs for each county/region in future applications, not just limited to the COVID-19 epidemic.

DFT and MD simulation investigation of favipiravir as an emerging antiviral option against viral protease (3CLpro) of SARS-CoV-2

As per date, around 20 million COVID-19 cases reported from across the globe due to a tiny 125 nm sized virus: SARS-CoV-2 which has created a pandemic and left an unforgettable impact on our world. Besides vaccine, medical community is in a race to identify an effective drug, which can fight against this disease effectively. Favipiravir (F) has recently attracted too much attention as an effective repurposed drug against COVID-19. In the present study, the pertinency of F has been tested as an antiviral option against viral protease (3CLpro) of SARS-CoV-2 with the help of density functional theory (DFT) and MD Simulation. Different electronic properties of F such as atomic charges, molecular electrostatic properties (MEP), chemical reactivity and absorption analysis have been studied by DFT. In order to understand the interaction and stability of inhibitor F against viral protease, molecular docking and MD simulation have been performed. Various output like interaction energies, number of intermolecular hydrogen bonding, binding energy etc. have established the elucidate role of F for the management of CoV-2 virus for which there is no approved therapies till now. Our findings highlighted the need to further evaluate F as a potential antiviral against SARS-CoV-2.

Virtual Screening in Search for a Chemical Probe for Angiotensin-Converting Enzyme 2 (ACE2)

We elaborate new models for ACE and ACE2 receptors with an excellent prediction power compared to previous models. We propose promising workflows for working with huge compound collections, thereby enabling us to discover optimized protocols for virtual screening management. The efficacy of elaborated roadmaps is demonstrated through the cost-effective molecular docking of 1.4 billion compounds. Savings of up to 10-fold in CPU time are demonstrated. These developments allowed us to evaluate ACE2/ACE selectivity in silico, which is a crucial checkpoint for developing chemical probes for ACE2.

Lung histopathologic clusters in severe COVID-19: a link between clinical picture and tissue damage

BACKGROUND

Autoptic pulmonary findings have been described in severe COVID-19 patients, but evidence regarding the correlation between clinical picture and lung histopathologic patterns is still weak.

METHODS

This was a retrospective cohort observational study conducted at the referral center for infectious diseases in northern Italy. Full lung autoptic findings and clinical data of patients who died from COVID-19 were analyzed. Lung histopathologic patterns were scored according to the extent of tissue damage. To consider coexisting histopathologic patterns, hierarchical clustering of histopathologic findings was applied.

RESULTS

Whole pulmonary examination was available in 75 out of 92 full autopsies. Forty-eight hospitalized patients (64%), 44 from ICU and four from the medical ward, had complete clinical data. The histopathologic patterns had a time-dependent distribution with considerable overlap among patterns. Duration of positive-pressure ventilation (p < 0.0001), mean positive end-expiratory pressure (PEEP) (p = 0.007), worst serum albumin (p = 0.017), interleukin 6 (p = 0.047), and kidney SOFA (p = 0.001) differed among histopathologic clusters. The amount of PEEP for long-lasting ventilatory treatment was associated with the cluster showing the largest areas of early and late proliferative diffuse alveolar damage. No pharmacologic interventions or comorbidities affected the lung histopathology.

CONCLUSIONS

Our study draws a comprehensive link between the clinical and pulmonary histopathologic findings in a large cohort of COVID-19 patients. These results highlight that the positive end-expiratory pressures and the duration of the ventilatory treatment correlate with lung histopathologic patterns, providing new clues to the knowledge of the pathophysiology of severe SARS-CoV-2 pneumonia.

Influence of COVID-19 Pandemic Uncertainty in Negative Emotional States and Resilience as Mediators against Suicide Ideation, Drug Addiction and Alcoholism

This research uses structural equation modeling to determine the influence of uncertainty due to the COVID-19 pandemic as an independent variable in the negative emotional states and resilience (as mediating variables) vs. drug addiction, alcoholism, and suicide ideation as dependent variables in 5557 students from a public state university in Northern Mexico. The five variables are related through eight hypotheses and tested using partial least squares. We used an adapted questionnaire sent by email in May 2020. Findings show that uncertainty facing the COVID-19 pandemic had a direct and significant influence on negative emotional states and a significant inverse effect on resilience; in the trajectory, drug addiction and alcoholism, and suicide ideation are explained.

Spectrum of COVID-19 clinical characteristics among patients presenting to the primary healthcare in Qatar during the early stages of the pandemic: a retrospective multicentre cross-sectional study

OBJECTIVES

To describe clinical characteristics and laboratory investigations of patients with COVID-19 diagnosed in primary care in Qatar and to assess predictors of hospitalisation.

DESIGN

A retrospective cross-sectional study.

SETTING AND PARTICIPANTS

3515 confirmed patients with COVID-19 diagnosed in any of the 27 primary healthcare centres in Qatar between 9 April 2020 and 30 June 2020.

MAIN OUTCOME MEASURES

Demographic characteristics, comorbidities, contact tracing, clinical and laboratory data, in addition to patient disposition at the time of diagnosis RESULTS: Mean age of patients was 35.5 years (±14.7). 2285 patients (65.0%) were males, 961 patients (27.3%) had a history of concomitant comorbidity and 640 patients (18.2%) were asymptomatic. Adult patients (19-64 years old) were more likely to report symptoms than children or elderly. Fever and cough were the most frequently documented symptoms affecting 1874 patients (46.7%) and 1318 patients (37.5%), respectively. Most patients had normal vital signs at presentation; however, patients who were subsequently hospitalised had higher median temperature than non-hospitalised patients (37.7°C, IQR: 37.0°C-38.4°C, and 37.2°C, IQR: 36.8°C-37.8°C, respectively). Hospitalised patients had significantly higher C reactive protein (CRP) (median CRP: 20 mg/L, IQR: 5.0-61.2 mg/L) than non-hospitalised patients (median CRP: 4.6 mg/L, IQR: 1.7-11.50 mg/L), and lower median absolute lymphocyte count (1.5×103/µL, IQR: 1.1×103/µL-2.1×103/µL, and 1.8×103/µL, IQR: 1.3×103/µL-2.4×103/µL, respectively). Predictors of hospitalisation were increasing age (adjusted OR (AOR): 2.614, 95% CI 1.281 to 5.332 for age between 50 years and 64 years, and AOR: 3.892, 95% CI 1.646 to 9.204 for age ≥65 years), presence of two or more comorbidities (AOR: 2.628; 95% CI 1.802 to 3.832) and presence of symptoms (AOR: 1.982: 95% CI 1.342 to 2.928).

CONCLUSION

The majority of COVID-19 cases diagnosed in primary healthcare in Qatar were symptomatic. Most cases had normal vital signs and laboratory results at presentation. Predictors of hospitalisation were increasing age, the presence of symptoms and having two or more comorbidities.

Impacts of short-term lockdown during COVID-19 on air quality in Egypt

COVID-19 is a pandemic disease that is actively spread over the globe in a few months. Most of the Nations took the appropriate measures including lockdown to reduce the risk of spreading and safe human health and life. Egypt took the measures of partial and complete lockdown from 15th March till 30th June 2020. Such short-term lockdown has had a significant impact on the reduction of emissions from transportation, industrial and human activities. This research used multi-data sensors from space to map the changes of air quality over Egypt in the first 6 months from January to June 2020 due to the lockdown and compare with previous years of 2018 and 2019. It is clearly observed that the air quality over the whole country is improved as a result of reducing pollutants emissions, with NO₂ reduced by 45.5%, CO emissions reduced by 46.23%, Ozone concentration decreased by about 61.1%, and AOD reduced by 68.5% compared to the previous 2 years. It is found that the lockdown is an effective mitigation measure against air pollution to improve air quality and reduce the air pollution that creates pressure on the human health and health system. It might be difficult to implement long lockdown, as a mitigation measure, due to its direct impact on social and economic needs. However, we recommend a complete lockdown for 2–3 days (long weekend) every at least 2-3 months, on national and/or global level, which will significantly enhance our air quality and improve the health environment of the planet.

Ischemic stroke associated with novel coronavirus 2019: a report of three cases

INTRODUCTION

There is limited evidence about the neurological manifestations of COVID-19 in infected patients. In this report, we describe three patients with ischemic stroke associated with COVID-19 infection.

METHODS

We report 3 cases of adult patients with ischemic stroke and novel coronavirus 2019 infection. Case 1 is an 88-year-old female with acute left hemiplegia and right peripheral facial paresis that she had a fever along with stroke symptoms. Case 2 is an 85-year-old female with left hemiplegia and drowsiness who had a weakness, asthenia, and dry cough 3 days before appearing stroke signs. Case 3 is a 55-year-old male with acute Broca's aphasia and right hemiplegia who experience fever and respiratory problems 3 days after admission.

RESULTS

The clinical symptoms of infected patients with COVID-19 have been associated with severe symptoms of ischemic stroke. Two patients were admitted to the ICU. RT-PCR of the oropharyngeal sample was positive in three cases. All patients had the involvement of large cerebral arteries.

CONCLUSION

The mechanism by which COVID-19 causes ischemic stroke is unknown but it is likely by production inflammatory cytokines or direct infection of cerebral arteries. Therefore, regarding the current situation of the COVID-19 pandemic, it is indispensable that the possible diagnosis of COVID-19 vasculopathy is considered in all ischemic strokes of unclear etiology.

Space-based monitoring of NO2 levels during COVID-19 lockdown in Cairo, Egypt and Riyadh, Saudi Arabia

The lockdown of COVID-19 pandemic has affected air quality due to the changes in human activities. Researchers worldwide observed reductions in NO₂ concentrations due to lockdown and related diminished human activities, notably the reduced industrial and vehicular use. However, limited information was available for the MENA Region. In this study, the impact of lockdown due to COVID-19 on NO₂ in two MENA major cities: Cairo, Egypt and Riyadh, Saudi Arabia was assessed. NO₂ column was retrieved from the Ozone Monitoring Instrument (OMI) on Aura for April 2017 to 2020. The monthly mean value of NO₂ concentrations of April 2017–2019 was used as a baseline. NO₂ concentration in April 2020 was compared to the baseline to assess the impact of lockdown on NO₂. The results demonstrated that the lockdown was associated with a reduction in NO₂ in both cities. NO₂ decreases by 40.3% and 23% in Riyadh and Cairo. By comparing the decrease of NO₂ at weekends and weekdays, it was found that in Cairo, the decrease in weekdays (16.3%) was lower than weekends (31.9%). While in Riyadh, the decrease in weekdays (43.9%) was higher than weekends (29.3%). Variation in the reduction rates appears to be related to the different lockdown regimens taken by the two countries, among other factors. The findings of the present investigation alert countries in the region about the impact of human activities on urban air population and urge them to take appropriate mitigation measures to maintain good ambient air quality to protect human health and the environment.

Transformation of urban mobility during COVID-19 pandemic - Lessons for transportation planning

INTRODUCTION

The coronavirus disease (COVID-19) pandemic is a global threat that started in Wuhan, China, in 2019 and spread rapidly to the globe. To reduce the spread of the COVID-19, different non-pharmacological control measures have been conducted in different countries, which include social distancing, distance working, and stay-at-home mandates. These control measures had affected global transportation and mobility significantly. This study investigated the short-term changes in urban mobility, tropospheric air pollution, and fuel consumption in two major cities of Saudi Arabia, namely, Riyadh and Jeddah.

METHODS

In this study, the dynamics of the number of trips and trip purposes in different provinces of the country were analyzed, focusing on the pandemic period and the lockdown program. These changes impacted fuel consumption and, consequently, air pollutants. The quantity of fuel consumption and its trend was projected considering a few possible fuel consumption and emission scenarios. It is also expected that fuel price plays a role in fuel consumption. The spatial and temporal distributions of the remote sensed tropospheric Nitrogen Dioxide (NO2) levels in different provinces were presented to depict the short 19 and long-term impact on the air quality due to the changes in mobility.

RESULTS

The significant reduction in urban mobility has been observed since the beginning of the first partial curfew in March 2020 compared to that in 2019. The air pollutant levels (such as NO2) in 2020 after the pandemic were generally less than those of 2019. The fuel consumption has been following a decreasing trend in 2020 starting from January due to dynamic fuel price and the additional influence of pandemic. Based on the current online shopping pattern, it is argued that there will be some permanent behavioral changes in urban mobility, which will decrease some shopping trips at least immediately after the recovery from the pandemic.

CONCLUSIONS

This study concluded that the availability of global urban mobility data, remote sensed based tropospheric air pollution data, and global fuel consumption database are important sources of information to investigate the impact of COVID pandemic, especially for the developing countries which suffer from scarcity of pertinent urban mobility information. It seems that, at least in the study area, the spread of COVID-19 is a complex phenomenon in which several exogenous factors, in addition to the curfew protocols, affect the spread of the virus.

The impact of gender on emotional reactions, perceived susceptibility and perceived knowledge about COVID-19 among the Israeli public

BACKGROUND

The current COVID-19 outbreak is seriously affecting the lives and health of people across the globe. While gender remains a key determinant of health, attempts to address the gendered dimensions of health face complex challenges.

METHODS

In a cross-sectional study 482 participants (men=237, women=245) completed questionnaires on precautionary behaviour, perceived knowledge about COVID-19 risk factors, emotional reactions toward COVID-19 and perceived susceptibility. We examined gender differences in perceived knowledge about COVID-19 risk factors, healthy behaviours, threat perceptions and emotional responses, as well as the role of gender as a moderating factor.

RESULTS

Women reported higher levels of precautionary behaviour (t(475)=3.91, p<0.001) and more negative emotional reactions toward COVID-19 (t(475)=6.07, p<0.001). No gender differences emerged in perceived susceptibility or knowledge about COVID-19. The multiple regression model is significant and explains 30% of the variance in precautionary behaviour, which was found to be higher among women and older participants, those with higher perceived knowledge about COVID-19 risk factors and those with higher emotional reactions. Gender exhibited a significant moderating role in the relationship between perceived knowledge and precautionary behaviour (B=0.16, SE=0.07, β=0.13, p=0.02, 95% CI 0.03 to 0.30).

CONCLUSION

Women exhibited higher levels of precautionary behaviour and emotional responses.

Multiplexed detection of respiratory pathogens with a portable analyzer in a "raw-sample-in and answer-out" manner

Coronavirus disease 2019 (COVID-19) has emerged, rapidly spread and caused significant morbidity and mortality worldwide. There is an urgent public health need for rapid, sensitive, specific, and on-site diagnostic tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this study, a fully integrated and portable analyzer was developed to detect SARS-CoV-2 from swab samples based on solid-phase nucleic acid extraction and reverse transcription loop-mediated isothermal amplification (RT-LAMP). The swab can be directly inserted into a cassette for multiplexed detection of respiratory pathogens without pre-preparation. The overall detection process, including swab rinsing, magnetic bead-based nucleic acid extraction, and 8-plex real-time RT-LAMP, can be automatically performed in the cassette within 80 min. The functionality of the cassette was validated by detecting the presence of a SARS-CoV-2 pseudovirus and three other respiratory pathogens, i.e., Klebsiella pneumoniae, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia. The limit of detection (LoD) for the SARS-CoV-2 pseudovirus was 2.5 copies/μL with both primer sets (N gene and ORF1ab gene), and the three bacterial species were successfully detected with an LoD of 2.5 colony-forming units (CFU)/μL in 800 μL of swab rinse. Thus, the analyzer developed in this study has the potential to rapidly detect SARS-CoV-2 and other respiratory pathogens on site in a “raw-sample-in and answer-out” manner.

Real-World Evidence of COVID-19 Patients' Data Quality in the Electronic Health Records

Despite the importance of electronic health records data, less attention has been given to data quality. This study aimed to evaluate the quality of COVID-19 patients' records and their readiness for secondary use. We conducted a retrospective chart review study of all COVID-19 inpatients in an academic healthcare hospital for the year 2020, which were identified using ICD-10 codes and case definition guidelines. COVID-19 signs and symptoms were higher in unstructured clinical notes than in structured coded data. COVID-19 cases were categorized as 218 (66.46%) "confirmed cases", 10 (3.05%) "probable cases", 9 (2.74%) "suspected cases", and 91 (27.74%) "no sufficient evidence". The identification of "probable cases" and "suspected cases" was more challenging than "confirmed cases" where laboratory confirmation was sufficient. The accuracy of the COVID-19 case identification was higher in laboratory tests than in ICD-10 codes. When validating using laboratory results, we found that ICD-10 codes were inaccurately assigned to 238 (72.56%) patients' records. "No sufficient evidence" records might indicate inaccurate and incomplete EHR data. Data quality evaluation should be incorporated to ensure patient safety and data readiness for secondary use research and predictive analytics. We encourage educational and training efforts to motivate healthcare providers regarding the importance of accurate documentation at the point-of-care.

Oral Manifestations of COVID-19 in Hospitalized Patients: A Systematic Review

Background: COVID-19 disease first appeared in 2019 and quickly spread worldwide, causing a global pandemic. The oral cavity represents a target of SARS-CoV-2, and oral lesions are observed in both non-hospitalized and hospitalized patients. This systematic review aims to investigate the frequency of oral manifestations in COVID-19 hospitalized patients. Methods: An electronic search was conducted in PubMed, Scopus, and Web of Science databases, including articles published up to September 2021. The review protocol was based on PRISMA-P. The risk of bias of the studies was assessed using the Joana Briggs Institute. The certainty of evidence was assessed using the GRADE instrument. Results: Fifty-nine articles were included: 19 case reports, 17 case series, 2 case-control studies, 13 cross-sectional studies, 4 observational studies, and 4 retrospective studies. Oral ulcers, cheilitis, and tongue lesions were more common in patients before hospitalization, while perioral pressure ulcers, macroglossia, blisters, and oral candidiasis were more recurrent in patients during hospitalization. The first could be related directly to COVID-19, while the latter could be caused by medical devices, treatments, prone position, and immunological impairment. Conclusions: An accurate oral examination during the hospital admission of all confirmed COVID-19 cases is encouraged to recognize oral early manifestations and to apply appropriate treatments.

A qualitative study to explore primary health care practitioners' perceptions and understanding regarding the COVID-19 pandemic in KwaZulu-Natal, South Africa

BACKGROUND

The coronavirus disease 2019 (COVID-19) is a novel virus that has rapidly spread across countries globally, and has been declared a pandemic by the World Health Organization (WHO). In South Africa, more that 1 million cases have been confirmed since case zero was detected in March 2020. South Africa is currently leading in the sub-Saharan African region in terms of COVID-19-related mortality and morbidity rates.

AIM

The aim of this study was to explore primary health care practitioners' perceptions and understanding regarding the COVID-19 pandemic in KwaZulu-Natal, South Africa.

SETTING

The study was conducted at two selected primary health care facilities (a community health centre and satellite clinic) within a low-income rural context in KwaZulu-Natal, South Africa.

METHODS

A qualitative study was conducted to explore and describe perceptions and understanding of primary health care practitioners regarding the COVID-19 pandemic in KwaZulu-Natal (KZN), South Africa. Data were collected from a purposive sample of 15 participants at two different clinics situated in rural KZN, South Africa. Participants comprised of nurses, physiotherapists, pharmacists, community care givers, social workers and clinical associates. The participants were both men and women who were all above the age of 20. Data were collected through individual, in-depth face-to-face interviews using a semi-structured interview guide. An audiotape was used to collect data, which were transcribed verbatim. Data were analysed manually by thematic analysis following Tech's steps of data analysis.

RESULTS

Participants reported pre-pandemic and pandemic perceptions of fear, denial, expectancy and a perceived poor preparation for the COVID-19 outbreak. The findings also revealed participants' misperceptions regarding the nature of the COVID-19 pandemic and unrealistic expectations of occupational compensations for working during the outbreak.

CONCLUSION

The findings of this study suggest that primary health care practitioners generally have negative perceptions and understanding regarding the pandemic because of misinformation obtained from social media. Interventions to support health care practitioners are necessary to mitigate the potentially negative implications of health practitioners' misconceptions on service delivery and their mental health.

The potential use of Drosophila as an in vivo model organism for COVID-19-related research: a review

The world urgently needs effective antiviral approaches against emerging viruses, as shown by the coronavirus disease 2019 (COVID-19) pandemic, which has become an exponentially growing health crisis. Scientists from diverse backgrounds have directed their efforts towards identifying key features of SARS-CoV-2 and clinical manifestations of COVID-19 infection. Reports of more transmissible variants of SARS-CoV-2 also raise concerns over the possibility of an explosive trajectory of the pandemic, so scientific attention should focus on developing new weapons to help win the fight against coronaviruses that may undergo further mutations in the future. Drosophila melanogaster offers a powerful and potential in vivo model that can significantly increase the efficiency of drug screening for viral and bacterial infections. Thanks to its genes with functional human homologs, Drosophila could play a significant role in such gene-editing studies geared towards designing vaccines and antiviral drugs for COVID-19. It can also help rectify current drawbacks of CRISPR-based therapeutics like off-target effects and delivery issues, representing another momentous step forward in healthcare. Here I present an overview of recent literature and the current state of knowledge, explaining how it can open up new avenues for Drosophila in our battle against infectious diseases.

Spatial and Temporal Trends of SARS-CoV-2 RNA from Wastewater Treatment Plants over 6 Weeks in Cape Town, South Africa

Recent scientific trends have revealed that the collection and analysis of data on the occurrence and fate of SARS-CoV-2 in wastewater may serve as an early warning system for COVID-19. In South Africa, the first COVID-19 epicenter emerged in the Western Cape Province. The City of Cape Town, located in the Western Cape Province, has approximately 4 million inhabitants. This study reports on the monitoring of SARS-CoV-2 RNA in the wastewater of the City of Cape Town's wastewater treatment plants (WWTPs) during the peak of the epidemic. During this period, the highest overall median viral RNA signal was observed in week 1 (9200 RNA copies/mL) and declined to 127 copies/mL in week 6. The overall decrease in the amount of detected viral SARS-CoV-2 RNA over the 6-week study period was associated with a declining number of newly identified COVID-19 cases in the city. The SARS-CoV-2 early warning system has now been established to detect future waves of COVID-19.

Astrocytes Downregulate Inflammation in Lipopolysaccharide-Induced Acute Respiratory Distress Syndrome: Applicability to COVID-19

Background: An acute respiratory distress syndrome (ARDS) is caused by the increased amounts of pro-inflammatory cytokines and neutrophil-mediated tissue injury. To date, there is no effective treatment for the ARDS available, while the need for one is growing due to the most severe complications of the current coronavirus disease-2019 (COVID-19) pandemic. The human astrocytes (AstroRx) have shown immunomodulatory properties in the central nervous system (CNS). This study aimed to evaluate the capacity of astrocytes to decrease lung inflammation and to be applied as a treatment therapy in ARDS.

Methods: First, we assessed the ability of clinical-grade AstroRx to suppress T-cell proliferation in a mixed lymphocyte reaction test. Next, we tested the therapeutical potential of AstroRx cells in a lipopolysaccharide (LPS)-based ARDS mouse model by injecting AstroRx intravenously (i.v). We determined the degree of lung injury by using a severity scoring scale of 0–2, based on the American Thoracic Society. The scoring measured the presence of neutrophils, fibrin deposits, and the thickening of alveolar walls. The state of inflammation was further assessed by quantifying the immune-cell infiltration to the bronchoalveolar lavage fluid (BALF) and by the presence of proinflammatory cytokines and chemokines in the BALF and serum.

Results: We detected that AstroRx cells were capable to suppress T-cell proliferation in vitro after exposure to the mitogen concanavalin A (ConA). In vivo, AstroRx cells were able to lower the degree of lung injury in LPS-treated animals compared with the sham injected animals (P = 0.039). In this study, 30% of AstroRx treated mice showed no lung lesions (responder mice), these mice presented a steady number of eosinophils, T cells, and neutrophils comparable with the level of naïve control mice. The inflammatory cytokines and chemokines, such as TNFα, IL1b, IL-6, and CXCL1, were also kept in check in responder AstroRx-treated mice and were not upregulated as in the sham-injected mice (P < 0.05). As a result, the LPS-treated ARDS mice had a higher survival rate when they were treated with AstroRx.

Conclusions: Our results demonstrate that the immunosuppressive activity of AstroRx cells support the application of AstroRx cells as a cell therapy treatment for ARDS. The immunoregulatory activity may also be a part of the mechanism of action of AstroRx reported in the amyotrophic lateral sclerosis (ALS) neurodegenerative disease.

Rationalistic approach in COVID-19 prevention through intervention of Unani medicine prevalent in epidemic - A review

Introduction

A novel coronavirus virus (2019-nCoV) emerged in China in December 2019 and achieved a high-risk category by the World Health Organization (WHO). The initial symptoms included fever, cough, dyspnea, and sore throat. The present review aims to evaluate the available evidence for the safety and efficacy of Unani herbal drugs and formulations in the prevention of Wabai Amraz (epidemic diseases) having resemblance to SARS-CoV-2.

Methods

Sources of data for this paper are classical Unani textbooks, Unani pharmacopeia of India, Indian Medicinal Plants-An Illustrated Dictionary, and published articles in various reputed peer-reviewed journals. Collected information was then critically analyzed.

Results

Despite great efforts, no specific treatment has been discovered for coronavirus yet. The best choices, therefore, are prevention and management. The Unani system of medicine offers health protection during epidemics. Three important interventions practised during an outbreak are (i) purification of the environment by using certain herbal drugs as fumigants which include vinegar (acetic acid) alone or combined with Ferula foetida Regel; (ii) promotion of health and immune modulation by using the pharmacopoeial preparations Khamira-e-Khashkhash and Khamira-e-Marwareed.

Conclusion

Several single drugs, as well as compound formulations, have been recommended in Unani medicine for the prevention and treatment of infectious diseases. The pharmacopoeial preparation Tiryaq-e-Nazla has been used for respiratory catarrhal inflammations and influenza by Hakims of the medieval period. Scientific research on these drugs reveals the presence of many pharmacologically active substances possessing significant antiviral, antipyretic, anti-tussive, and immune-modulatory properties, which can give new insight into infection and epidemic management.

COVID-19 prediction based on genome similarity of human SARS-CoV-2 and bat SARS-CoV-like coronavirus

This paper proposes an efficient and accurate method to predict coronavirus disease 19 (COVID-19) based on the genome similarity of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and a bat SARS-CoV-like coronavirus. We introduce similarity features to distinguish COVID-19 from other human coronaviruses by comparing human coronaviruses with a bat SARS-CoV-like coronavirus. In the proposed method each human coronavirus sequence is assigned to three similarity scores considering nucleotide similarities and mutations that lead to the strong absence of cytosine and guanine nucleotides. Next the proposed features are integrated with CpG island features of the genome sequences to improve COVID-19 prediction. Thus, each genome sequence is represented by five real numbers. We exhibit the effectiveness of the proposed features using six machine learning classifiers on a dataset including the genome sequences of human coronaviruses similar to SARS-CoV-2. The performances of the machine learning classifiers are close to each other and k-nearest neighbor classifier with similarity features achieves the best results with an accuracy of 99.2%. Moreover, k-nearest neighbor classifier with the integration of CpG based and similarity features has an admirable performance and achieves an accuracy of 99.8%. Experimental results demonstrate that similarity features remarkably decrease the number of false negatives and significantly improve the overall performance. The superiority of the proposed method is also highlighted by comparing with the state-of-the-art studies detecting COVID-19 from genome sequences.

Factors associated with poor outcomes among hospitalized patients with COVID-19: Experience from a MERS-CoV referral hospital

BACKGROUND

Coronavirus disease 2019 (COVID-19) has resulted in millions of deaths, including more than 6000 deaths in the Kingdom of Saudi Arabia (KSA). Identifying key predictors of intensive care unit (ICU) admission and mortality among infected cases would help in identifying individuals at risk to optimize their care. We aimed to determine factors of poor outcomes in hospitalized patients with COVID-19 in a large academic hospital in Riyadh, KSA that serves as a Middle East Respiratory Syndrome coronavirus (MERS-CoV) referral center.

METHODS

This is a single-center retrospective cohort study of hospitalized patients between March 15 and August 31, 2020. The study was conducted at King Saud University Medical City (KSUMC). COVID-19 infection was confirmed using real-time reverse transcriptase polymerase chain reaction (RT-PCR) for SARS-COV-2. Demographic data, clinical characteristics, laboratory, radiological features, and length of hospital stay were obtained. Poor outcomes were, admission to ICU, need for invasive mechanical ventilation (IMV), and in-hospital all-cause mortality.

RESULTS

Out of 16,947 individuals tested in KSUMC, 3480 (20.5%) tested positive for SARS-CoV-2 and of those 743 patients (21%) were hospitalized. There were 62% males, 77% were younger than 65 years. Of all cases, 204 patients (28%) required ICU admission, 104 (14%) required IMV, and 117 (16%) died in hospital. In bivariate analysis, multiple factors were associated with mortality among COVID-19 patients. Further multivariate analysis revealed the following factors were associated with mortality: respiratory rate more than 24/min and systolic blood pressure <90 mmHg in the first 24h of presentation, lymphocyte count <1 × 109/L and aspartate transaminase level >37 units/L in the first 48 h of presentation, while a RT-PCR cycle threshold (Ct) value ≤24 was a predictor for IMV.

CONCLUSION

Variable factors were identified as predictors of different outcomes among COVID-19 patients. The only predictor of IMV was a low initial Ct values of SARS-CoV-2 PCR. The presence of tachypnea, hypotension, lymphopenia, and elevated AST in the first 48h of presentation were independently associated with mortality. This study provides possible independent predictors of mortality and invasive mechanical ventilation. The data may be helpful in the early identification of high-risk COVID-19 patients in areas endemic with MERS-CoV.

Association Between Periodontal Disease and the Risk of COVID-19 Complications and Mortality: A Systematic Review

AIM

The COVID-19 pandemic has strained the world's healthcare systems. Studies have identified how the COVID-19 infections are linked to several co-morbidities such as hypertension, diabetes, cardiovascular disease, renal and pulmonary disease. It is known that periodontal disease (PD) shares the same risk factors. Moreover, both diseases are characterized by an exaggerated immune response. The aim of the study was to investigate the available evidence of a potential association between PD and the risk of COVID-19 complications and mortality.

MATERIALS AND METHODS

MEDLINE/PubMed, EMBASE, Scopus, and ProQuest were searched. Studies that assess the association between PD and the risk of COVID-19 complications and mortality were eligible for inclusion. Two independent reviewers performed the selection of articles and data extraction. The New Castle Ottawa Scale was used to assess the quality of the selected studies, and the GRADE system was used to evaluate the level of confidence to support the conclusions.

RESULTS

Only two studies met the eligibility criteria. One study had a low risk of bias, whereas the other had a high risk of bias.

CONCLUSION

The level of confidence in the available evidence is very low. A close association between periodontitis and the risk of COVID-19 complications and mortality can neither be supported nor refuted.

Estimation of viral kinetics model parameters in young and aged SARS-CoV-2 infected macaques

The SARS-CoV-2 virus disproportionately causes serious illness and death in older individuals. In order to have the greatest impact in decreasing the human toll caused by the virus, antiviral treatment should be targeted to older patients. For this, we need a better understanding of the differences in viral dynamics between SARS-CoV-2 infection in younger and older adults. In this study, we use previously published averaged viral titre measurements from the nose and throat of SARS-CoV-2 infection in young and aged cynomolgus macaques to parametrize a viral kinetics model. We find that all viral kinetics parameters differ between young and aged macaques in the nasal passages, but that there are fewer differences in parameter estimates from the throat. We further use our parametrized model to study the antiviral treatment of young and aged animals, finding that early antiviral treatment is more likely to lead to a lengthening of the infection in aged animals, but not in young animals.

Computed tomography after severe COVID-19 pneumonia: findings at 6 months and beyond

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects the alveolar epithelial cells causing coronavirus disease (COVID-19) pneumonia of varying severity [1, 2]. 15–30% of patients develop acute respiratory distress syndrome (ARDS) requiring hospitalisation in intensive care units (ICU) and mechanical ventilation [2, 3]. At 3 months, there are persisting computed tomography (CT) abnormalities in 17 to 91% of discharged COVID-19 patients [4–8], mainly consistent with an organising pneumonia (OP) pattern. These anomalies are more frequently reported in patients who were admitted to ICU [9]. Pulmonary fibrosis has been reported at autopsy of patients deceased from COVID-19 pneumonia, along with pulmonary microvascular thrombosis [10].

Parenchymal bands and ground-glass opacities consistent with a pattern of late organising pneumonia are frequently observed 6 months after ICU admission for #COVID19, whereas fibrotic changes of limited extent are only observed in about 1/3 of patientshttps://bit.ly/2UGOsbr

COVID-19 and Indirect Liver Injury: A Narrative Synthesis of the Evidence

The liver is frequently affected by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection. The most common manifestations are mildly elevated alanine aminotransferase and aspartate aminotransferase, with a prevalence of 16-53% among patients. Cases with severe coronavirus disease 2019 (COVID-19) seem to have higher rates of acute liver dysfunction, and the presence of abnormal liver tests at admission signifies a higher risk of severe disease during hospitalization. Patients with chronic liver diseases also have a higher risk of severe disease and mortality (mainly seen in patients with metabolic-associated fatty liver disease). Several pathways of damage have been proposed in the liver involvement of COVID-19 patients; although, the end-cause is most likely multifactorial. Abnormal liver tests have been attributed to the expression of angiotensin-converting enzyme 2 receptors in SARS-CoV-2 infection. This enzyme is expressed widely in cholangiocytes and less in hepatocytes. Other factors attributed to liver damage include drug-induced liver injury, uncontrolled release of proinflammatory molecules ("cytokine storm"), pneumonia-associated hypoxia, and direct damage by the infection. Hepatic steatosis, vascular thrombosis, fibrosis, and inflammatory features (including Kupffer cell hyperplasia) are the most common liver histopathological findings in deceased COVID-19 patients, suggesting important indirect mechanisms of liver damage. In this translational medicine-based narrative review, we summarize the current data on the possible indirect mechanisms involved in liver damage due to COVID-19, the histopathological findings, and the impact of these mechanisms in patients with chronic liver disease.

Physicochemical Characteristics and In Vitro Toxicity/Anti-SARS-CoV-2 Activity of Favipiravir Solid Lipid Nanoparticles (SLNs)

The rise of coronavirus (COVID-19) cases worldwide has driven the need to discover and develop novel therapeutics with superior efficacy to treat this disease. This study aims to develop an innovative aerosolized nano-formulation of favipiravir (FPV) as an anti-viral agent against coronavirus infection. The local delivery of FPV nanoparticles (NPs) via nebulization ensures that the drug can reach the site of infection, the lungs. Solid lipid NPs of favipiravir (FPV-SLNs) were formulated utilizing the hot-evaporation method. The physicochemical formulation properties were evaluated using dynamic light scattering (DLS), Fourier-transform infrared spectroscopy (FTIR), and differential scanning calorimetry (DSC). The aerosol formulation performance was evaluated using an Andersen Cascade Impactor (ACI) at a flow rate of 15 L/min. The FPV-SLN formulation's in vitro anti-viral activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was also evaluated using the SARS-CoV-2 pathogen (hCoV-19/Egypt/NRC-3/2020 isolate). The FPV-SLNs' morphology was defined utilizing transmission electron microscopy, showing an irregular shape. By means of FPV-SLNs' nebulization, a fine particle fraction of 60.2 ± 1.7% was produced with 60.2 ± 1.7%, and this finding suggests that FPV-SLNs were appropriate for inhalation drug delivery with a particle size of 537.6 ± 55.72 nm. Importantly, the FPV-SLNs showed anti-viral activity against SARS-CoV-2 with CC50 and IC50 values of 449.6 and 29.9 µg/mL, respectively. This study suggests that inhaled solid lipid NPs of favipiravir could potentially be used against coronavirus.

Evolution of RNA viruses from SARS to SARS-CoV-2 and diagnostic techniques for COVID-19: a review

Background

From the start of the twenty-first century up to the year 2021, RNA viruses are the main causative agents of the majority of the disease outbreaks the world has confronted. Recently published reviews on SARS-CoV-2 have mainly focused on its structure, development of the outbreak, relevant precautions, management trials and available therapies. However, in this review, we aim to explore the history, evolution of all coronaviruses and the associated viral outbreaks along with the diagnostics for COVID-19 in the twenty-first century.

Main body

We have focused on different RNA viruses’ viz. SARS-CoV, MERS-CoV, and SARS-CoV-2, their classification, and the various disease outbreaks caused by them. In the subsequent section, the comparison of different RNA viruses affecting humans has been made based on the viral genome, structure, time of the outbreak, mode of spread, virulence, causative agents, and transmission. Due to the current mayhem caused by the rapidly emerging virus, special attention is given to SARS-CoV-2, its genome updates, and infectivity. Finally, the current diagnostic techniques such as nucleic acid testing (real time-polymerase chain reaction and loop-mediated isothermal amplification), CRISPR-based diagnostics (CRISPR based DETECTR assay, CRISPR based SHERLOCK test, AIOD-CRISPR, FELUDA, CREST), chest radiographs (computed tomography, X-ray), and serological tests (Lateral flow assay, enzyme-linked immunosorbent assay, chemiluminescent immunoassay, neutralization assay, nano-sensors, blood test, viral sequencing) with their pros and cons, and future diagnostic prospective have been described.

Conclusions

The present gloomy scenario mandates clinical manifestations, contact tracing, and laboratory tests as important parameters that need to be taken into consideration to make the final diagnosis.

Highly Efficient Purification of Recombinant VSV-∆G-Spike Vaccine against SARS-CoV-2 by Flow-Through Chromatography

This study reports a highly efficient, rapid one-step purification process for the production of the recombinant vesicular stomatitis virus-based vaccine, rVSV-∆G-spike (rVSV-S), recently developed by the Israel Institute for Biological Research (IIBR) for the prevention of COVID-19. Several purification strategies are evaluated using a variety of chromatography methods, including membrane adsorbers and packed-bed ion-exchange chromatography. Cell harvest is initially treated with endonuclease, clarified, and further concentrated by ultrafiltration before chromatography purification. The use of anion-exchange chromatography in all forms results in strong binding of the virus to the media, necessitating a high salt concentration for elution. The large virus and spike protein binds very strongly to the high surface area of the membrane adsorbents, resulting in poor virus recovery (<15%), while the use of packed-bed chromatography, where the surface area is smaller, achieves better recovery (up to 33%). Finally, a highly efficient chromatography purification process with Capto^TM Core 700 resin, which does not require binding and the elution of the virus, is described. rVSV-S cannot enter the inner pores of the resin and is collected in the flow-through eluent. Purification of the rVSV-S virus with Capto^TM Core 700 resulted in viral infectivity above 85% for this step, with the efficient removal of host cell proteins, consistent with regulatory requirements. Similar results were obtained without an initial ultrafiltration step.