Biology of COVID-19 and related viruses: Epidemiology, signs, symptoms, diagnosis, and treatment

The influence of acute lifestyle changes on NAFLD evolution in a multicentre cohort: a matter of body composition

BACKGROUND

Unhealthy lifestyles represent a key element fueling Non-alcoholic fatty liver disease (NAFLD) onset and worsening. We aimed to evaluate the effects of forced acute lifestyle changes on NAFLD evolution.

METHODS

187 NAFLD patients were followed two years pre- and two years during the lockdown social restrictions in three Italian medical centers. For each patient, biochemical, clinical, non-invasive liver fibrosis, nutritional, and body composition data were collected.

RESULTS

An increase in fats and carbohydrate intake associated with impaired weekly physical activity during the lockdown was demonstrated as well as an increase in body mass index and waist-hip-ratio (p < 0.0001 for all). Total cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides, glucose, insulin, homeostatic model assessment for insulin resistance, and transaminases worsened during the lockdown (glucose: p = 0.0007; p < 0.0001 for the others). Moreover, NAFLD fibrosis score, liver stiffness, and controlled attenuation parameter were also impaired during the same period (p < 0.0001 for all). The bioelectrical impedance analysis (BIA) evidenced an increase of fat mass (FM), and a reduction of free fat mass (FFM) and body cell mass (BCM) (p < 0.0001 for all). The lockdown overall hepatocellular carcinoma (HCC) and Milan-out HCC occurrence revealed Hazard Ratio (HR): 2.398, 95% Confidence Interval (CI):1.16-5, p = 0.02, and HR:5.931, CI:2-17.6, p = 0.008 respectively. A liver disease stage and comorbidities independent association between both the assessed outcomes and body composition analysis in terms of mean values and variation (T1-T2 Δ) was demonstrated.

CONCLUSIONS

The acute lifestyle changes impacted NAFLD evolution via body composition modifications negatively influencing the HCC occurrence.

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

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

Cost and performance analysis of efficiency, efficacy, and effectiveness of viral RNA isolation with commercial kits and Heat Shock as an alternative method to detect SARS-CoV-2 by RT-PCR

In late 2019 a new virus reported in Wuhan, China, identified as SARS-CoV-2 spread rapidly challenging the healthcare system around the world. The need for rapid, timely and accurate detection was critical to the prevention of community outbreaks of the virus. However, the high global demand for reagents during the years 2020 and 2021 generated a bottleneck in kits used for detection, greatly affecting developing countries, lagging their ability to diagnose and control the virus in the population. The difficulty in importing reagents, high costs and limited public access to the SARS-CoV-2 detection test led to the search for alternative methods. In this framework, different commercial nucleic acid extraction methodologies were evaluated and compared against heat shock as an alternative method for SARS-CoV-2 detection by RT-PCR, in order to determine the diagnostic yield and its possible low-cost compared to other methodologies. Nasopharyngeal samples were used where the diagnostic efficiency of the alternative method was 70 to 73%. The evaluation of the discriminatory efficacy of the method took the sensitivity and specificity to establish its cut-off point, being 0.73 to 0.817, which allows discriminating between COVID-19 positives and negatives. As for the diagnostic effectiveness expressed as the proportion of subjects correctly classified, it is between 80 and 84%. On the other hand, in terms of the costs necessary to carry out the detection, the alternative method is more economical and accessible in terms of direct cost close to 47 and 49 USD, and indirect cost around 35 and 50 USD compared to the commercial methods available in this comparison and evaluation, being possible its implementation in developing countries with high infection rates, allowing access to the diagnostic test with a reliable and low-cost method. Keywords: COVID-19, RT-PCR, Viral RNA.

Social capital and the COVID-19 pandemic threat: The Russian experience

Social capital is an important resource for the wellbeing of both the individual and society. Since the beginning of the COVID-19 pandemic, many studies have been conducted to explore the role of social capital in coping with the negative consequences of the pandemic. However, how the pandemic itself can affect the social capital of people has yet to be studied. Try to fill this gap, we aimed at testing the association between the individually perceived coronavirus threat and such indicators of social capital as general social trust, institutional trust, and the quality of various types of people's social relationships (with family, friends, colleagues, neighbors, residents of a locality, residents of a country). Data were collected in different regions of the Russian Federation for a convenience sample of 500 respondents. The study found that the individually perceived coronavirus threat was positively associated with institutional trust, but not with general social trust. Moreover, this covariation was moderated by age: an institutional trust-threat relation emerged only in older respondents with an average age of around 60, but not in younger participants. Furthermore, the study found that perceived coronavirus threat was associated with closer relationships in the family, but simultaneously with an increased distance in relations with neighbors and residents of the respondents' locality. In summary, the study indicated that "strong" ties (i.e., with family, colleagues, and friends) either remained unchanged or were intensified in the face of the pandemic threat, whereas "weak" ties (i.e., with neighbors, residents of the same locality, and fellow citizens) tended to weaken even more.

Predictors of COVID-19 Hospital Treatment Outcome

Background

There are more than 228,394,572 confirmed cases and 4,690,186 confirmed deaths caused by COVID-19 worldwide. The magnitude of the COOVID-19 pandemic has stimulated research on the treatment and diagnosis of COVID-19 patients.

Objective

In this report, a battery of specific parameters was used to develop a model that allows prediction of the outcome of the COVID-19 treatment. These parameters are C-reactive protein, procalcitonin, fibrinogen, D-dimers, immature granulocytes, and interleukin-6.

Methods

The study was carried out on a sample of N = 49 survivors (22 men, 27 women) and 83 deceased patients (62 men, 21 women). The distribution of means and differences in means of the parameters studied between survivors and deceased patients were evaluated using the bootstrap method.

Results

A mathematical model that allows for the prediction of hospitalization outcome was obtained using the Naive Bayes model. The results demonstrated a statistically significant difference between survivors and deceased patients in all parameters studied. A mathematical model employing a battery of parameters provided a 97% precision in predicting the outcome of hospitalization.

Conclusion

This study showed that the cross-correlation of survivability with absolute levels of C-reactive protein, procalcitonin, fibrinogen, D-dimers, immature granulocytes, and interleukin-6 could be used successfully in the hospital setting as a diagnostic tool.

Maxillary Mucormycosis Osteomyelitis in Post COVID-19 Patients: A Series of Fourteen Cases

During the current pandemic of COVID-19, numerous manifestations and complications have developed. Patients with COVID-19 are at high risk of fungal infections, such as mucormycosis, that may result directly from COVID-19 infection and/or as a side effect of the drugs used in COVID-19 treatment protocol, such as dexamethasone, hydroxychloroquine, and antibiotics. In this report, we described a series of 14 cases with maxillary mucormycosis osteomyelitis in immediate post-COVID-19 patients.

COVID-19 vaccines and nanomedicine

Background

The COVID‐19 virus‐induced pandemic has been the deadliest pandemic to have occurred in two generations, besides HIV/AIDS. Epidemiologists predicted that the SARS‐Cov 2 pandemic would not be able to be brought under control until a majority of the world’s population had been inoculated with safe and effective vaccines. A world‐wide effort to expedite vaccine development was successful. Previous research for vaccines to prevent SARS and MERS, also coronaviruses, was vital to this success. Nanotechnology was essential to this vaccine development. Key elements are presented here to better understand the relationship between nanomedicine and the COVID‐19 vaccine development.

Methods

NLM PubMed searches for COVID‐19 vaccines, nanotechnology and nanomedicine were done. There were 6911 articles screened, 235 of which were deemed appropriate to this subject and utilized here, together with two landmark nanomedicine texts used to expand understanding of the basic science of nanotechnology.

Results

SARS‐Cov 2, caused by the COVID‐19 virus, was first recognized in China in December of 2019 and was declared as a pandemic in March of 2020. The RNA sequence was identified in January of 2020. Within 4 months of the viral genome being released, over 259 vaccines had been in development. The World Health Organization (WHO) anticipated a vaccine with a 50‐80% efficacy to be developed within 1‐2 years. Ahead of schedule, the Food and Drug Administration (FDA) announced the emergency authorization approval for two mRNA vaccines within 11 month’s time. Nanotechnology was the key to the success of these rapidly developed, safe and effective vaccines. A brief review of pertinent basic science principles of nanomedicine are presented. The development of COVID vaccines is reviewed. Future considerations are discussed.

Conclusions

Control of the COVID‐19 SARS‐Cov2 pandemic benefitted from nanomedicine principles used to develop highly effective, yet very safe and relatively inexpensive vaccines. These nanovaccines can be much more easily altered to adjust for viral variants than traditional live or inactivated legacy‐type whole virus vaccines.