Diagnosis and treatment of coronavirus disease 2019 (COVID-19): Laboratory, PCR, and chest CT imaging findings

Performance of CO-RADS in the diagnosis of COVID-19 in hemodialysis patients

INTRODUCTION

Different data systems have been used to reach a common decision in the interpretation of chest computed tomography (CT) scans for the detection of COVID-19 infection. The aim of our study was to determine the usefulness of the COVID-19 Reporting and Data System (CO-RADS) for COVID-19 in patients undergoing hemodialysis.

METHODS

We included 90 hemodialysis patients who underwent chest CT and had samples available for real-time reverse transcription-polymerase chain reaction (RT-PCR). The files of the patients were retrospectively reviewed and the data were recorded. Image interpretation and CO-RADS staging were performed retrospectively by two radiologists experienced in COVID-19 patients, blinded to the RT-PCR results. The RT-PCR results were then compared with the CO-RADS stages obtained. The success of CO-RADS in diagnosing COVID-19 was evaluated according to its prediction of a positive RT-PCR result. At the same time, the relationship between CO-RADS stages and prognosis was also evaluated.

RESULTS

Patients were divided into two groups according to the RT-PCR results, of which 38 (42.2%) had positive results. Validity tests of CO-RADS were performed according to the RT-PCR test. While 71.1% of patients with CO-RADS ≥4 were RT-PCR (+), 13.2% of patients with CO-RADS ≤2 were RT-PCR (+) (p < 0.001). CO-RADS ≥4 detected COVID-19 with 71.1% sensitivity and 51.9% specificity. ROC analysis confirmed the diagnostic performance of CO-RADS for predicting RT-PCR positivity with AUC = 0.73 (95% CI: 0.63-0.84). The relationship between CO-RADS stages and mortality was not significant (p = 0.21).

CONCLUSION

CO-RADS is moderately sensitive and poorly specific for the diagnosis of COVID-19 in hemodialysis patients. In these patients, CO-RADS would be more useful to exclude other infections than to diagnose COVID-19.

No Distinct Cytokine, Chemokine, and Growth Factor Blood Profile Associated With Monkeypox Virus Clade IIb Infected Patients

Previous studies indicated Clade I monkeypox virus infection to be associated with marked elevation of proinflammatory cytokines. This remains unexplored for Clade II-associated disease, which has different clinical manifestations and prognosis. We used a 65-plex cytokine, chemokine, and growth factor (CCG) panel to analyze serum samples of 100 male acute Clade IIb mpox patients and 26 healthy controls in Belgium. Cluster analyses revealed no strong or distinct CCG profiles distinguishing mpox patients from controls but suggested trends in certain cytokine modulation. Individual CCG analyses found elevated levels of cytokines (MIF, CD30, IL2R, IL18, APRIL, and TNFRII), chemokines (CCL4, CCL8, CCL22, CCL24, CXCL9, CXCL10, CXCL11, CXCL12, and CXCL13), and growth factors (HGF and VEGFA) in patients, while CCL11 and CXCL5 were significantly suppressed. We detected no differences in key proinflammatory cytokines, IL-1α, IL-1β, IL-6, IL-8 or anti-inflammatory cytokines, IL-4, IL-10, IL-13. In patients living with HIV, comparison with pre-outbreak samples showed an increase in CXCL13 and a decrease in CXCL5, CCL2, CCL24, HGF, SCF, and TWEAK. The absence of discriminatory CCG profiles in Clade IIb mpox patients compared to healthy controls suggests there may be limited clinical applications of those markers.

Emergence of coinfection with visceral Leishmania infantum in COVID-19 patients: a case‒control field study in an endemic area of visceral leishmaniasis in Iran

BACKGROUND

COVID-19 is a pandemic involving coinfection with other opportunistic microorganisms, including parasites such as Leishmania infantum. The present study aimed to determine the frequency of L. infantum infection and its role in disease and mortality among symptomatic COVID-19 patients in comparison with the non-COVID-19 control group in the endemic area of visceral leishmaniasis (VL) in Iran.

METHODS

A total of 250 blood samples from hospitalized COVID-19 patients and 231 blood samples from non-COVID-19 patients as a control group were collected in Mashkin Shahr city, Iran from October 2020 to May 2021, and anti-Leishmania infantum antibodies were detected via direct agglutination test (DAT). For confirmation of non-COVID-19 samples as the control group, anti-COVID-19 IgG antibodies were measured via indirect ELISA. Additionally, demographic data, clinical data, and disease outcomes were recorded.

RESULTS

Overall, 46 (18.4%) COVID-19 patients and 18 (7.8%) non-COVID-19 patients had anti-Leishmania infantum antibodies at titers of 1:200 or higher according to the DAT (p value[Formula: see text] 0.05). In the COVID-19 group, there was no statistically significant association between coinfection with L. infantum and sex, residency, treatment outcome, or symptoms.

CONCLUSION

The results of this study revealed that the overall seroprevalence of L. infantum infection among patients with COVID-19 was 2.66 times greater than that in the control group, which was statistically significant. It seems that L. infantum infection can be considered a risk factor for COVID-19, particularly in VL endemic areas.

CLINICAL TRIAL NUMBER

Not applicable.

Effect of Remote Ischaemic Conditioning on the Inflammatory Cytokine Cascade of COVID-19 (RIC in COVID-19): a Randomized Controlled Trial

PURPOSE

Patients hospitalized with COVID-19 may develop a hyperinflammatory, dysregulated cytokine "storm" that rapidly progresses to acute respiratory distress syndrome, multiple organ dysfunction, and even death. Remote ischaemic conditioning (RIC) has elicited anti-inflammatory and cytoprotective benefits by reducing cytokines following sepsis in animal studies. Therefore, we investigated whether RIC would mitigate the inflammatory cytokine cascade induced by COVID-19.

METHODS

We conducted a prospective, multicentre, randomized, sham-controlled, single-blind trial in Brazil and South Africa. Non-critically ill adult patients with COVID-19 pneumonia were randomly allocated (1:1) to receive either RIC (intermittent ischaemia/reperfusion applied through four 5-min cycles of inflation (20 mmHg above systolic blood pressure) and deflation of an automated blood-pressure cuff) or sham for approximately 15 days. Serum was collected following RIC/sham administration and analyzed for inflammatory cytokines using flow cytometry. The endpoint was the change in serum cytokine concentrations. Participants were followed for 30 days.

RESULTS

Eighty randomized participants (40 RIC and 40 sham) completed the trial. Baseline characteristics according to trial intervention were overall balanced. Despite downward trajectories of all cytokines across hospitalization, we observed no substantial changes in cytokine concentrations after successive days of RIC. Time to clinical improvement was similar in both groups (HR 1.66; 95% CI, 0.938-2.948, p 0.08). Overall RIC did not demonstrate a significant impact on the composite outcome of all-cause death or clinical deterioration (HR 1.19; 95% CI, 0.616-2.295, p = 0.61).

CONCLUSION

RIC did not reduce the hypercytokinaemia induced by COVID-19 or prevent clinical deterioration to critical care.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04699227.

Altered orientation dispersion index of white matter in individuals with insomnia during the COVID-19 pandemic: A study combining neuroimaging technique and Mendelian randomization

STUDY OBJECTIVES

Coronavirus disease 2019 (COVID-19) can lead to insomnia. However, associations between COVID-19-caused insomnia and white matter (WM) changes are unclear.

METHODS

All subjects had ever been infected with COVID-19. We investigated 89 insomniacs (29 chronic insomniacs, 33 new-onset insomniacs, 27 aggravated insomniacs) and 44 matched non-insomnia participants. Neurite orientation dispersion and density imaging (NODDI) was performed to identify micro-structural alterations of WM, and twelve scales related to sleeping status, memory, attention, learning, emotional status, and executive functions were used. Then, correlations between insomnia/cognitive-behavioral functions and diffusion metrics were tested. To eliminate influence of pre-COVID-19 factors on insomnia, causal relationships between COVID-19 and WM changes were validated by Mendelian randomization (MR) analysis. The significant brain regions of COVID-19-caused insomnia were intersected results of tract-based spatial statistics (TBSS) and MR analyses.

RESULTS

Compared to non-insomnia group, insomnia group and its subgroups including post-COVID-19 aggravated or unchanged chronic insomnia group had higher orientation dispersion index (ODI) in extensive brain regions. The left superior longitudinal fasciculus (SLF), left posterior thalamic radiation (PTR), and left cingulate gyrus (CG) were specific brain regions in COVID-19-induced insomnia aggravation. After Bonferroni correction, partial correlation analyses within insomnia group showed that ODI in left SLF was positively correlated with Pittsburgh sleep quality index (PSQI), insomnia severity index (ISI), and self-rating anxiety scale (SAS) scores; ODI in the left PTR was positively correlated with PSQI and ISI scores.

CONCLUSIONS

This study is a continuation of our previous research, which provided potential biomarkers for COVID-19-induced insomnia.

An Open One-Step RT-qPCR for SARS-CoV-2 detection

The COVID-19 pandemic has resulted in millions of deaths globally, and while several diagnostic systems were proposed, real-time reverse transcription polymerase chain reaction (RT-PCR) remains the gold standard. However, diagnostic reagents, including enzymes used in RT-PCR, are subject to centralized production models and intellectual property restrictions, which present a challenge for less developed countries. With the aim of generating a standardized One-Step open RT-qPCR protocol to detect SARS-CoV-2 RNA in clinical samples, we purified and tested recombinant enzymes and a non-proprietary buffer. The protocol utilized M-MLV RT and Taq DNA pol enzymes to perform a Taqman probe-based assay. Synthetic RNA samples were used to validate the One-Step RT-qPCR components, demonstrating sensitivity comparable to a commercial kit routinely employed in clinical settings for patient diagnosis. Further evaluation on 40 clinical samples (20 positive and 20 negative) confirmed its comparable diagnostic accuracy. This study represents a proof of concept for an open approach to developing diagnostic kits for viral infections and diseases, which could provide a cost-effective and accessible solution for less developed countries.

Ebselen: A Review on its Synthesis, Derivatives, Anticancer Efficacy and Utility in Combating SARS-COV-2

Ebselen is a selenoorganic chiral compound with antioxidant properties comparable to glutathione peroxidase. It is also known as 2-phenyl-1,2-benzisoselenazol-3(2H)-one. In studies examining its numerous pharmacological activities, including antioxidant, anticancer, antiviral, and anti- Alzheimer's, ebselen has demonstrated promising results. This review's primary objective was to emphasize the numerous synthesis pathways of ebselen and their efficacy in fighting cancer. The data were collected from multiple sources, including Scopus, PubMed, Google Scholar, Web of Science, and Publons. The starting reagents for the synthesis of ebselen are 2-aminobenzoic acid and N-phenyl benzamide. It was discovered that ebselen has the ability to initiate apoptosis in malignant cells and prevent the formation of new cancer cells by scavenging free radicals. In addition, ebselen increases tumor cell susceptibility to apoptosis by inhibiting TNF-α mediated NF-kB activation. Ebselen can inhibit both doxorubicin and daunorubicin-induced cardiotoxicity. Allopurinol and ebselen administered orally can be used to suppress renal ototoxicity and nephrotoxicity. Due to excessive administration, diclofenac can induce malignancy of the gastrointestinal tract, which ebselen can effectively suppress. Recent research has demonstrated ebselen to inhibit viral function by binding to cysteinecontaining catalytic domains of various viral proteases. It was discovered that ebselen could inhibit the catalytic dyad function of Mpro by forming an irreversible covalent bond between Se and Cys145, thereby altering protease function and inhibiting SARS-CoV-2. Ebselen may also inhibit the activation of endosomal NADPH oxidase of vascular endothelial cells, which is believed to be required for thrombotic complications in COVID-19. In this review, we have included various studies conducted on the anticancer effect of ebselen as well as its inhibition of SARS-CoV-2.

Lung Ultrasonography Is an Acceptable Imaging Modality to Diagnose COVID-19 and Effectively Correlates with HRCT Chest-A Prospective Study

It has been validated beyond doubt that High-Resolution Computed Tomography (HRCT) chest and to some extent chest radiographs have a role in corona virus disease-19 (COVID-19). Much less is known about the role of lung ultrasonography (LUS) in COVID-19. In this paper, our main purpose was to gauge the relationship between LUS and chest HRCT in reverse transcriptase polymerase chain reaction (RT-PCR) documented cases of COVID-19, as well as in those with high suspicion of COVID-19 with negative RT-PCR. It was a prospective study carried out at our tertiary care hospital, namely, SKIMS Soura. The total number of patients in this study were 152 (200 patients were selected out of which only 152 had undergone both LUS and chest HRCT). The patients were subjected to both LUS and chest HRCT. The radiologist who performed LUS was blinded to clinical findings and HRCT was evaluated by a radiologist with about a decade of experience. The LUS findings compatible with the disease were subpleural consolidations, B-lines and irregular pleural lines. Findings that were compatible with COVID-19 on chest HRCT were bibasilar, subpleural predominant ground glass opacities, crazy paving and consolidations. COVID-19-positive patients were taken up for chest HRCT for disease severity stratification and were also subjected to LUS. On HRCT chest, the imaging abnormalities compatible with COVID-19 were evident in 110 individuals (72.37%), and on Lung Ultrasound they were observed in 120 individuals (78.95%). Imaging of COVID-19 patients assessed by both LUS and HRCT chest,, showed a positive correlation (p < 0.0001). The study revealed a sensitivity of 88%, a specificity of 76.62%, a positive predictive value of 78.57% and a negative predictive value of 86.76%. None of the individuals with a diagnosis of COVID-19 on HRCT were missed on LUS. An excellent correlation was derived between the LUS score and CT total severity score (p < 0.0001 with a kappa of 0.431). Similar precision compared with chest HRCT in the detection of chest flaws in COVID-19 patients was obtained on LUS.

A Review of Crucial Radiological Investigations in the Management of COVID-19 Cases

Chest X-ray, chest CT, and lung ultrasound are the most common radiological interventions used in the diagnosis and management of coronavirus disease 2019 (COVID-19) patients. The purpose of this literature review, which was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, is to determine which radiological investigation is crucial for that purpose. PubMed, Medline, American Journal of Radiology (AJR), Public Library of Science (PLOS), Elsevier, National Center for Biotechnology Information (NCBI), and ScienceDirect were explored. Seventy-two articles were reviewed for potential inclusion, including 50 discussing chest CT, 15 discussing chest X-ray, five discussing lung ultrasound, and two discussing COVID-19 epidemiology. The reported sensitivities and specificities for chest CT ranged from 64 to 98% and 25 to 88%, respectively. The reported sensitivities and specificities for chest X-rays ranged from 33 to 89% and 11.1 to 88.9%, respectively. The reported sensitivities and specificities for lung ultrasound ranged from 93 to 96.8% and 21.3 to 95%, respectively. The most common findings on chest CT include ground glass opacities and consolidation. The most common findings on chest X-rays include opacities, consolidation, and pleural effusion. The data indicate that chest CT is the most effective radiological tool for the diagnosis and management of COVID-19 patients. The authors support the continued use of reverse transcription polymerase chain reaction (RT-PCR), along with physical examination and contact history, for such diagnosis. Chest CT could be more appropriate in emergency situations when quick triage of patients is necessary before RT-PCR results are available. CT can also be used to visualize the progression of COVID-19 pneumonia and to identify potential false positive RT-PCR results. Chest X-ray and lung ultrasound are acceptable in situations where chest CT is unavailable or contraindicated.

Predicting the Severity of COVID-19 from Lung CT Images Using Novel Deep Learning

Purpose

Coronavirus 2019 (COVID-19) had major social, medical, and economic impacts globally. The study aims to develop a deep-learning model that can predict the severity of COVID-19 in patients based on CT images of their lungs.

Methods

COVID-19 causes lung infections, and qRT-PCR is an essential tool used to detect virus infection. However, qRT-PCR is inadequate for detecting the severity of the disease and the extent to which it affects the lung. In this paper, we aim to determine the severity level of COVID-19 by studying lung CT scans of people diagnosed with the virus.

Results

We used images from King Abdullah University Hospital in Jordan; we collected our dataset from 875 cases with 2205 CT images. A radiologist classified the images into four levels of severity: normal, mild, moderate, and severe. We used various deep-learning algorithms to predict the severity of lung diseases. The results show that the best deep-learning algorithm used is Resnet101, with an accuracy score of 99.5% and a data loss rate of 0.03%.

Conclusion

The proposed model assisted in diagnosing and treating COVID-19 patients and helped improve patient outcomes.

Learning from pseudo-lesion: a self-supervised framework for COVID-19 diagnosis

The Coronavirus disease 2019 (COVID-19) has rapidly spread all over the world since its first report in December 2019, and thoracic computed tomography (CT) has become one of the main tools for its diagnosis. In recent years, deep learning-based approaches have shown impressive performance in myriad image recognition tasks. However, they usually require a large number of annotated data for training. Inspired by ground glass opacity, a common finding in COIVD-19 patient's CT scans, we proposed in this paper a novel self-supervised pretraining method based on pseudo-lesion generation and restoration for COVID-19 diagnosis. We used Perlin noise, a gradient noise based mathematical model, to generate lesion-like patterns, which were then randomly pasted to the lung regions of normal CT images to generate pseudo-COVID-19 images. The pairs of normal and pseudo-COVID-19 images were then used to train an encoder-decoder architecture-based U-Net for image restoration, which does not require any labeled data. The pretrained encoder was then fine-tuned using labeled data for COVID-19 diagnosis task. Two public COVID-19 diagnosis datasets made up of CT images were employed for evaluation. Comprehensive experimental results demonstrated that the proposed self-supervised learning approach could extract better feature representation for COVID-19 diagnosis, and the accuracy of the proposed method outperformed the supervised model pretrained on large-scale images by 6.57% and 3.03% on SARS-CoV-2 dataset and Jinan COVID-19 dataset, respectively.

Role of Glucagon-like Peptide-1 (GLP-1) Agonists in the Management of Diabetic Patients with or without COVID-19

Glucagon-like peptide 1 (GLP-1) is a gut-derived hormone released after a meal, which alleviates hyperglycemia, increases β-cell survival, reduces body weight, and reduces inflammation. These thrilling effects motivated clinical studies to discover the potential use of GLP-1 receptor agonists (GLP-1 RAs) in the management of T2D. GLP-1 RAs are potential anti-diabetic agents that can reduce blood pressure, glucose levels, HbA1c and, weight loss without hypoglycemia risk. This manuscript reviews the importance of GLP-1 RAs‎ and their role in the management of T2D with or without COVID-19 infection. Hence, this manuscript can help physicians and researchers to choose the most appropriate drugs for the individualized treatment of subjects.

mRNA-Based Vaccines and Therapeutics for COVID-19 and Future Pandemics

An unheard mobilization of resources to find SARS-CoV-2 vaccines and therapies has been sparked by the COVID-19 pandemic. Two years ago, COVID-19's launch propelled mRNA-based technologies into the public eye. Knowledge gained from mRNA technology used to combat COVID-19 is assisting in the creation of treatments and vaccines to treat existing illnesses and may avert pandemics in the future. Exploiting the capacity of mRNA to create therapeutic proteins to impede or treat a variety of illnesses, including cancer, is the main goal of the quickly developing, highly multidisciplinary field of biomedicine. In this review, we explore the potential of mRNA as a vaccine and therapeutic using current research findings.

COVID-19 Outbreak Related to PM10, PM2.5, Air Temperature and Relative Humidity in Ahvaz, Iran

In this study, we assessed several points related to the incidence of COVID-19 between March 2020 and March 2021 in the Petroleum Hospital of Ahvaz (Iran) by analyzing COVID-19 data from patients referred to the hospital. We found that 57.5% of infected referrals were male, 61.7% of deaths by COVID-19 occurred in subjects over 65 years of age, and only 2.4% of deaths occurred in younger subjects (< 30 years old). Analysis showed that mean PM₁₀ and PM_2.5 concentrations were correlated to the incidence of COVID-19 (r = 0.547, P < 0.05, and r = 0.609, P < 0.05, respectively) and positive chest CT scans (r = 0.597, P < 0.05, and r = 0.541, P < 0.05 respectively). We observed that a high daily air temperature (30–51 °C) and a high relative humidity (60–97%) led to a significant reduction in the daily incidence of COVID-19. The highest number of positive chest CT scans were obtained in June 2020 and March 2021 for daily air temperature ranging from 38 °C and 49 °C and 11 °C and 15 °C, respectively. A negative correlation was detected between COVID-19 cases and air temperature (r =  − 0.320, P < 0.05) and relative humidity (r =  − 0.384, P < 0.05). In Ahvaz, a daily air temperature of 10–28 °C and relative humidity of 19–40% are suitable for the spread of coronavirus. The highest correlation with the number of COVID-19 cases was found at lag3 (r = 0.42) and at lag0 with a positive chest CT scan (r = 0.56). For air temperature and relative humidity, the highest correlations were found at day 0 (lag0). During lockdown (22 March to 21 April 2020), a reduction was observed for PM₁₀ (29.6%), PM_2.5 (36.9%) and the Air Quality Index (33.3%) when compared to the previous month. During the pandemic period (2020–2021), the annual mean concentrations of PM₁₀ (27.3%) and PM_2.5 (17.8%) were reduced compared to the 2015–2019 period.

The Mechanisms of Zinc Action as a Potent Anti-Viral Agent: The Clinical Therapeutic Implication in COVID-19

The pandemic of COVID-19 was caused by a novel coronavirus termed as SARS-CoV2 and is still ongoing with high morbidity and mortality rates in the whole world. The pathogenesis of COVID-19 is highly linked with over-active immune and inflammatory responses, leading to activated cytokine storm, which contribute to ARDS with worsen outcome. Currently, there is no effective therapeutic drug for the treatment of COVID-19. Zinc is known to act as an immune modulator, which plays an important role in immune defense system. Recently, zinc has been widely considered as an anti-inflammatory and anti-oxidant agent. Accumulating numbers of studies have revealed that zinc plays an important role in antiviral immunity in several viral infections. Several early clinical trials clearly indicate that zinc treatment remarkably decreased the severity of the upper respiratory infection of rhinovirus in humans. Currently, zinc has been used for the therapeutic intervention of COVID-19 in many different clinical trials. Several clinical studies reveal that zinc treatment using a combination of HCQ and zinc pronouncedly reduced symptom score and the rates of hospital admission and mortality in COVID-19 patients. These data support that zinc might act as an anti-viral agent in the addition to its anti-inflammatory and anti-oxidant properties for the adjuvant therapeutic intervention of COVID-19.

Restoration of vascular endothelial integrity by mesenchymal stromal/stem cells in debilitating virus diseases

Endothelial dysfunction is one of the key cornerstone complications of emerging and re-emerging viruses which lead to vascular leakage and a high mortality rate. The mechanism that regulates the origin of endothelial dysregulation is not completely elucidated. Currently, there are no potential pharmacological treatments and curable management for such diseases. In this sense, mesenchymal stromal/stem cells (MSCs) has been emerging to be a promising therapeutic strategy in restoring endothelial barrier function in various lung disease, including ALI and ARDS. The mechanism of the role of MSCs in restoring endothelial integrity among single-strand RNA (ssRNA) viruses that target endothelial cells remains elusive. Thus, we have discussed the therapeutic role of MSCs in restoring vascular integrity by (i) inhibiting the metalloprotease activity thereby preventing the cleavage of tight junction proteins, which are essential for maintaining membrane integrity (ii) possessing antioxidant properties which neutralize the excessive ROS production due to virus infection and its associated hyper host immune response (iii) modulating micro RNAs that regulate the endothelial activation and its integrity by downregulating the inflammatory response during ssRNA infection.

Influenza A, Influenza B, and SARS-CoV-2 Similarities and Differences – A Focus on Diagnosis

In late December 2019, the first cases of viral pneumonia caused by an unidentified pathogen were reported in China. Two years later, SARS-CoV-2 was responsible for almost 450 million cases, claiming more than 6 million lives. The COVID-19 pandemic strained the limits of healthcare systems all across the world. Identifying viral RNA through real-time reverse transcription-polymerase chain reaction remains the gold standard in diagnosing SARS-CoV-2 infection. However, equipment cost, availability, and the need for trained personnel limited testing capacity. Through an unprecedented research effort, new diagnostic techniques such as rapid diagnostic testing, isothermal amplification techniques, and next-generation sequencing were developed, enabling accurate and accessible diagnosis. Influenza viruses are responsible for seasonal outbreaks infecting up to a quarter of the human population worldwide. Influenza and SARS-CoV-2 present with flu-like symptoms, making the differential diagnosis challenging solely on clinical presentation. Healthcare systems are likely to be faced with overlapping SARS-CoV-2 and Influenza outbreaks. This review aims to present the similarities and differences of both infections while focusing on the diagnosis. We discuss the clinical presentation of Influenza and SARS-CoV-2 and techniques available for diagnosis. Furthermore, we summarize available data regarding the multiplex diagnostic assay of both viral infections.

Evaluation of thorax computed tomographic findings in COVID-19 variant cases

BACKGROUND

Because of genetic mutations occurring during viral replication, new SARS-CoV-2 variants will continue to emerge. Throughout the COVID-19 pandemic, thorax computed tomographic (CT) findings have played a crucial role in the diagnosis and follow-up of patients with COVID-19. In this study, we compared the thorax CT findings of patients infected with SARS-CoV-2 variants (variant group) with those of patients infected with the non-variant strain (non-variant group) to assess if thorax CT findings may be utilized to discriminate between the groups. Furthermore, we compared demographic and laboratory data between the groups.

METHODS

The study comprised a total of 77 patients who presented to our hospital with a preliminary diagnosis of COVID-19 based on clinical symptoms, a positive oropharyngeal/nasopharyngeal swab RT-PCR testing, and thorax CT examinations. Patients' laboratory and demographic features as well as thorax CT findings were retrospectively evaluated, and the results were grouped according to RT-PCR results.

RESULTS

There were 42 patients in the non-variant group and 35 patients in the variant group. The average age of patients infected with the non-variant strain, alpha variant, and gamma variant was 63.52 ± 14.87 years, 54.86 ± 14.31 years, and 59.4 ± 17.79 years, respectively. The average age of the variant group was significantly lower than that of the non-variant group. There was no significant difference in thorax CT findings between the groups, and consolidation, ground glass densities, and cobblestone pattern in the bilateral lower lobes and peripheral areas were the most common thorax CT findings in both the groups.

CONCLUSION

There is no significant difference in thorax CT findings between the variant and non-variant groups. Therefore, clinical and laboratory characteristics should take precedence over thorax CT findings for distinguishing between patients infected with SARS-CoV-2 variants and the non-variant strain.

Label-Free Covid-19 lesion segmentation based on synthetic healthy lung image subtraction

PURPOSE

COVID-19 has become a global pandemic and is still posing a severe health risk to the public. Accurate and efficient segmentation of pneumonia lesions in CT scans is vital for treatment decision-making. We proposed a novel unsupervised approach using cycle consistent generative adversarial network (cycle-GAN) which automates and accelerates the process of lesion delineation.

METHOD

The workflow includes lung volume segmentation, healthy lung image synthesis, infected and healthy image subtraction, and binary lesion mask creation. The lung volume was first delineated using a pre-trained U-net and worked as the input for the following network. A cycle-GAN was developed to generate synthetic healthy lung CT images from infected lung images. After that, the pneumonia lesions are extracted by subtracting the synthetic healthy lung CT images from the infected lung CT images. A median filter and K-means clustering were then applied to contour the lesions. The auto segmentation approach was validated on three different datasets.

RESULTS

The average Dice coefficient reached 0.666±0.178 on the three datasets. Especially, the dice reached 0.748±0.121 and 0.730±0.095, respectively, on two public datasets Coronacases and Radiopedia. Meanwhile, the average precision and sensitivity for lesion segmentation on the three datasets were 0.679±0.244 and 0.756±0.162. The performance is comparable to existing supervised segmentation networks and outperforms unsupervised ones.

CONCLUSION

The proposed label-free segmentation method achieved high accuracy and efficiency in automatic COVID-19 lesion delineation. The segmentation result can serve as a baseline for further manual modification and a quality assurance tool for lesion diagnosis. Furthermore, due to its unsupervised nature, the result is not influenced by physicians' experience which otherwise is crucial for supervised methods. This article is protected by copyright. All rights reserved.

Statistical analysis of COVID-19 infection severity in lung lobes from chest CT

Detection of the COVID 19 virus is possible through the reverse transcription-polymerase chain reaction (RT-PCR) kits and computed tomography (CT) images of the lungs. Diagnosis via CT images provides a faster diagnosis than the RT-PCR method does. In addition to low false-negative rate, CT is also used for prognosis in determining the severity of the disease and the proposed treatment method. In this study, we estimated a probability density function (PDF) to examine the infections caused by the virus. We collected 232 chest CT of suspected patients and had them labeled by two radiologists in 6 classes, including a healthy class and 5 classes of different infection severity. To segment the lung lobes, we used a pre-trained U-Net model with an average Dice similarity coefficient (DSC) greater than 0.96. First, we extracted the PDF to grade the infection of each lobe and selected five specific thresholds as feature vectors. We then assigned this feature vector to a support vector machine (SVM) model and made the final prediction of the infection severity. Using the T-Test statistics, we calculated the p-value at different pixel thresholds and reported the significant differences in the pixel values. In most cases, the p-value was less than 0.05. Our developed model was developed on roughly labeled data without any manual segmentation, which estimated lung infection involvements with the area under the curve (AUC) in the range of [0.64, 0.87]. The introduced model can be used to generate a systematic automated report for individual patients infected by COVID-19.

Diagnostic performance of CO-RADS for COVID-19: a systematic review and meta-analysis

Objectives

To investigate the diagnostic performance of the coronavirus disease 2019 (COVID-19) Reporting and Data System (CO-RADS) for detecting COVID-19.

Methods

We searched PubMed, EMBASE, MEDLINE, Web of Science, Cochrane Library, and Scopus database until September 21, 2021. Statistical analysis included data pooling, forest plot construction, heterogeneity testing, meta-regression, and subgroup analyses.

Results

We included 24 studies with 8382 patients. The pooled sensitivity and specificity and the area under the curve (AUC) of CO-RADS ≥ 3 for detecting COVID-19 were 0.89 (95% confidence interval (CI) 0.85–0.93), 0.68 (95% CI 0.60–0.75), and 0.87 (95% CI 0.84–0.90), respectively. The pooled sensitivity and specificity and AUC of CO-RADS ≥ 4 were 0.83 (95% CI 0.79–0.87), 0.84 (95% CI 0.78–0.88), and 0.90 (95% CI 0.87–0.92), respectively. Cochran’s Q test (p < 0.01) and Higgins I² heterogeneity index revealed considerable heterogeneity. Studies with both symptomatic and asymptomatic patients had higher specificity than those with only symptomatic patients using CO-RADS ≥ 3 and CO-RADS ≥ 4. Using CO-RADS ≥ 4, studies with participants aged < 60 years had higher sensitivity (0.88 vs. 0.80, p = 0.02) and lower specificity (0.77 vs. 0.87, p = 0.01) than studies with participants aged > 60 years.

Conclusions

CO-RADS has favorable performance in detecting COVID-19. CO-RADS ≥ 3/4 might be applied as cutoff values given their high sensitivity and specificity. However, there is a need for more well-designed studies on CO-RADS.

Key Points

• CO-RADS shows a favorable performance in detecting COVID-19.

• CO-RADS ≥ 3 had a high sensitivity 0.89 (95% CI 0.85–0.93), and it may prove advantageous in screening the potentially infected people to prevent the spread of COVID-19.

• CO-RADS ≥ 4 had high specificity 0.84 (95% CI 0.78–0.88) and may be more suitable for definite diagnosis of COVID-19.

Multi-objective optimisation of polymerase chain reaction continuous flow systems

A surrogate-enabled multi-objective optimisation methodology for a continuous flow Polymerase Chain Reaction (CFPCR) systems is presented, which enables the effect of the applied PCR protocol and the channel width in the extension zone on four practical objectives of interest, to be explored. High fidelity, conjugate heat transfer (CHT) simulations are combined with Machine Learning to create accurate surrogate models of DNA amplification efficiency, total residence time, total substrate volume and pressure drop throughout the design space for a practical CFPCR device with sigmoid-shape microfluidic channels. A series of single objective optimisations are carried out which demonstrate that DNA concentration, pressure drop, total residence time and total substrate volume within a single unitcell can be improved by up to [Formula: see text]5.7%, [Formula: see text]80.5%, [Formula: see text]17.8% and [Formula: see text]43.2% respectively, for the practical cases considered. The methodology is then extended to a multi-objective problem, where a scientifically-rigorous procedure is needed to allow designers to strike appropriate compromises between the competing objectives. A series of multi-objective optimisation results are presented in the form of a Pareto surface, which show for example how manufacturing and operating cost reductions from device miniaturisation and reduced power consumption can be achieved with minimal impact on DNA amplification efficiency. DNA amplification has been found to be strongly related to the residence time in the extension zone, but not related to the residence times in denaturation and annealing zones.

Comprehensive Review on Rapid Diagnosis of New Infection COVID-19

Generally, rapid detection of viral infection is necessary for preventing the virus from spreading among people in a society as a pandemic. Although there are many effective standard techniques used for virus identification, they are laborious, required skilled person to handle and time-consuming. Particularly, the detection of viral infection involved in the isolation and nucleic acid detection by collecting specimens (sample) from the appropriate sites. For instance, oral or nasal swab, nasopharyngeal or tracheal extract, lung tissue, blood, sputum and feces are collected in order to investigate the pandemic, COVID-19 for the effective and rapid diagnosis and eventually for the treatment. In this mini-review, it is summarized that the advanced testing methods which include RNA, immunologic and radiological based tests that could be used to detect COVID-19 and their cost, reliability and functionality are discussed in this review. This mini-review might help the researcher and health care sector to plan the diagnostic procedures as per the severity of the new infection, COVID-19.

Successful Treatment of Encephalitis Following SARS-Cov-2 Infection: A Case Report

Background

The SARS-CoV-2 invades the cells by attachment of virus spike proteins (S1, S2) to cell membrane and engages angiotensin-converting enzyme 2 (ACE2), which is highly expressed in the epithelium of cerebral vasculature. Here, we describe a patient with encephalitis following SARS-CoV-2 infection.

Case presentation

A 77-year-old male patient presented with mild cough and coryza lasting for eight days without a prior history of underlying disease or neurologic disorder. Oxygen saturation (SatO₂) was decreased and behavioral changes, confusion, and headaches were started within three days prior to admission. Bilateral ground glass opacifications and consolidations were noted on chest CT scan. Lymphopenia, highly elevated D-Dimer and ferritin were noted in laboratory results. Brain CT and MRI showed no changes regarding encephalitis. Cerebrospinal fluid was collected as the symptoms persisted. The results of SARS-CoV-2 RNA RT-PCR from CSF and nasopharyngeal samples were positive. The combination therapy with remdesivir, interferon beta-1alpha and methylprednisolone was started. Due to deterioration of the patient's status and SatO_2, he was admitted to the ICU and intubated. Tocilizumab, dexamethasone, and mannitol were started. The patient was extubated on the 16th day of ICU admission. The patient's level of consciousness and SatO₂ were improved. He was discharged from the hospital a week later.

Conclusion

RT-PCR of CSF sample along with brain imaging can help with diagnosis when encephalitis due to SARS-CoV-2 is suspected. However, no changes regarding encephalitis may be seen on brain CT or MRI. Combination therapy with antivirals, interferon beta, corticosteroids, and tocilizumab can help patients recover in these conditions.

Genetic Predisposition and Inflammatory Inhibitors in COVID-19: Where Do We Stand?

Severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) and the resulting coronavirus disease-19 (COVID-19) have led to a global pandemic associated with high fatality rates. COVID-19 primarily manifests in the respiratory system as an acute respiratory distress syndrome following viral entry through the angiotensin-converting enzyme-2 (ACE2) that is present in pulmonary epithelial cells. Central in COVID-19 is the burst of cytokines, known as a "cytokine storm", and the subsequent widespread endothelial activation, leading to cardiovascular complications such as myocarditis, arrhythmias, and adverse vascular events, among others. Genetic alterations may play an additive, detrimental role in the clinical course of patients with COVID-19, since gene alterations concerning ACE2, major histocompatibility complex class I, and toll-like receptors may predispose patients to a worse clinical outcome. Since the role of inflammation is quintessential in COVID-19, pharmacologic inhibition of various signaling pathways such as the interleukin-1 and -6, tumor necrosis factor-alpha, interferon gamma, Janus kinase-signal transducer and activator of transcription, and granulocyte-macrophage colony-stimulating factor may ameliorate the prognosis following timely administration. Finally, frequently used, non-specific anti-inflammatory agents such as corticosteroids, statins, colchicine, and macrolides represent additional therapeutic considerations.

Chest computed tomography findings in more than 4,000 non-hospitalized suspected COVID-19 patients

Background

When the first wave of COVID-19 outbreak occurred, the infrastructure for definitive detection of the disease through real-time polymerase chain reaction (RT-PCR) was not yet available in many regions, and a large proportion of suspected patients were inevitably referred to radiology centers to provide a chest CT scan. This research was conducted to describe chest CT characteristics in patients who underwent chest CT during the first weeks of COVID-19 outbreak in Babol, Iran.

Methods

All non-hospitalized suspected COVID-19 patients referred to the state radiologic clinic to perform chest CT from March 8, 2020 to March 28, 2020 have been enrolled in this observational study. All CT scans were reviewed by a faculty member radiologist with approximately 20 years of experience.

Results

Totally, 2,207 (52.3%) men and 2016 (47.7%) women have been examined. Imaging characteristics in 2292 (54.3%) individuals illustrated a highly suggestive sign of COVID-19 infection while 1869 (44.3%) had a normal chest CT scan. 1813 cases (77.00%) had bilateral involvement and 541 cases (23.00%) were infected unilaterally; Also, 1727 (73.36%) patients had left-sided involvement. Lung field involvement in 2036 (86.49%) patients was less than 20%. Ground glass opacity had a sensitivity, specificity, PPV, NPV, LR+ and LR- of 99%, 96%, 96%, 98%, 22 and 0.01, respectively, for categorization of a patient as a COVID-19 case. These values were 99%, 73%, 70%, 99%, 3.72% and 0.01%, respectively for consolidations.

Conclusion

Although, RT-PCR is still introduced as the gold standard method for definite diagnosis, diagnostic accuracy of chest CT in COVID-19 detection is considerable.

A Narrative Review of COVID-19 Vaccines

The COVID-19 pandemic has shaken the world since early 2020 and its health, social, economic, and societal negative impacts at the global scale have been catastrophic. Since the early days of the pandemic, development of safe and effective vaccines was judged to be the best possible tool to minimize the effects of this pandemic. Drastic public health measures were put into place to stop the spread of the virus, with the hope that vaccines would be available soon. Thanks to the extraordinary commitments of many organizations and individuals from around the globe and the collaborative effort of many international scientists, vaccines against COVID-19 received regulatory approval for emergency human use in many jurisdictions in less than a year after the identification of the viral sequence. Several of these vaccines have been in use for some time; however, the pandemic is still ongoing and likely to persist for the foreseeable future. This is due to many reasons including reduced compliance with public health restrictions, limited vaccine manufacturing/distribution capacity, high rates of vaccine hesitancy, and the emergence of new variants with the capacity to spread more easily and to evade current vaccines. Here we discuss the discovery and availability of COVID-19 vaccines and evolving issues around mass vaccination programs.

Effect of anxiety on COVID-19 infection in hemodialysis patients

Some evidence suggests that anxiety deteriorate the immune system. We aimed to determine the effect of anxiety on COVID‐19 infection in hemodialysis (HD) patients. Our study was conducted with 80 HD patients. State‐Trait Anxiety Inventory (STAI), and Beck Anxiety Inventory (BAI) questionnaires were administered between April 15 and May 1, 2020. These patients were followed up for about 8 months and COVID‐19 infection, hospitalization, and death rates were recorded. Twenty‐one (26%) of the patients were diagnosed with COVID‐19 infection. Fourteen out of twenty one (66.6%) of the patients were hospitalized, and 8/21 (38%) of them died due to COVID‐19. STAI‐S (p= 0.006) and BAI (p= 0.021) scores were found to be higher and STAI‐T (p= 0.040) score was found to be lower in HD patients who were infected with COVID‐19 compared to without, at the follow‐up period. It might be concluded in this study that COVID‐19 was more common in anxious HD patients.

Nanoparticles as an effective drug delivery system in COVID-19

BACKGROUND

The global healthcare sector has been dealing with a situation known as a novel severe acute respiratory syndrome (SARS-CoV-2) since the end of 2019. Covid-19 is an acronym for Covid-19 (Coronavirus Disease- 2019). It causes a respiratory infection that includes cold, sneezing and coughing, and pneumonia. In the case of an animal, it causes diarrhea and upper respiratory diseases. Covid-19 transmitted human to human via airborne droplets. First Covid-19 emerged in Wuhan market China and it spread rapidly throughout the World. As we know nanoparticles are a novel drug delivery system. They have various advantageous effects like increasing the efficacy of the drug, safety, etc. In this review, we study about the nanoparticles and summarize how it is effective during drug delivery system in Covid-19. Chitosan is a much focused biopolymeric nanoparticle. It delivers drugs to the specific target site. In a recent health crisis, chitosan nanoparticles are one of the ways to release drugs of Covid-19, and specifically in the lungs of the affected patients. We studied and extracted our data from various research papers, review papers, and some other articles.

OBJECTIVE

The main goal is to study the nanoparticles and their future aspects which is an effective drug delivery system in Covid-19.

METHODS

The bibliographic search was done through a systematic search. The terms "Nanoparticles", "Covid-19 ", "Drug delivery" etc. were used to search the databases/search engines like "Google Scholar", "NCBI", "PubMed", "Science Direct" etc. These databases and search engines used here perform the limited criteria of search to conduct a systematic literature survey for the study and report writing. All the text from the articles and research papers were studied and analyzed. The various articles and research papers were used in writing this report and all of which are mentioned in the reference section of this report.

CONCLUSION

Our current studies reveal that nanoparticles may prove very helpful in the delivery of drugs for Covid-19 treatment. Many cases showed that patients, where drugs are delivered with the help of nanoparticles, produced very few side effects.

High Seroprevalence of SARS-CoV-2 (COVID-19)-Specific Antibodies among Healthcare Workers: A Cross-Sectional Study in Guilan, Iran

Background

This study was conducted to evaluate the anti‐SARS‐CoV‐2 IgM and IgG antibodies among healthcare workers in Guilan.

Methods

This cross-sectional study was conducted on 503 healthcare workers. Between April and May 2020, blood samples were collected from the healthcare workers of Razi Hospital in Rasht, Guilan, Iran. Enzyme-linked immunosorbent assay (ELISA) was used for the detection and quantitation of anti‐SARS‐CoV‐2 IgM/IgG antibodies by using kits made by Pishtaz Teb Company, Tehran, Iran.

Results

From a total of 503 participants, the result of the anti‐SARS‐CoV‐2 IgM antibody test was positive in 28 subjects (5.6%) and the anti‐SARS‐CoV‐2 IgG antibody test was positive in171 subjects (34%). Participants in the age group of 35–54 years were significantly more likely to have a positive anti‐SARS‐CoV‐2 antibody test than the age group of 20–34 years (odds ratio = 1.53, 95% CI: 1.04–2.25, P=0.029). Also, physicians were significantly more likely to have a positive antibody test than office workers (odds ratio = 1.92, 95% CI: 1.04–3.54, P=0.037). The wide range of symptoms was significantly associated with the positive anti‐SARS‐CoV‐2 antibody test. The most significant association was observed between fever and a positive anti‐SARS‐CoV‐2 antibody test (odds ratio = 3.03, 95% CI: 2.06–4.44, P < 0.001).

Conclusion

The results of the current study indicated that the seroprevalence of COVID-19 was high among healthcare workers of Guilan Province. It seems that this finding was due to the earlier exposure to COVID-19 and the lack of awareness and preparedness to deal with the pandemic in Iran, compared to other countries.

Pitfalls in chest CT findings of COVID-19 patients infected during hospitalisation

OBJECTIVE

This study evaluated the differences in the appearance of COVID-19 pneumonia on chest computed tomography (CT) images of outpatient and cases that developed during hospitalisation.

METHOD

Chest CT images of 66 patients (median age, 76 years; range, 29-94 years) who underwent the severe acute respiratory syndrome coronavirus-2 reverse-transcription polymerase chain reaction (RT-PCR) test were included in this retrospective study. The chest CT appearance was categorised as "typical," "indeterminate," "atypical," or "negative" in accordance with the recommendations of the Radiological Society of North America for COVID-19 pneumonia and compared among the following four subgroups: PCR-positive outpatient (n = 14); PCR-positive hospitalised (n = 7); PCR-negative outpatient (n = 9); and PCR-negative hospitalised (n = 36).

FINDINGS

The frequency of "typical" findings in the PCR-positive outpatient cases (13/14, 92.9%) was significantly higher than that of those in the PCR-positive hospitalised cases (2/7, 28.6%, P = 0.022). There was no significant difference between the frequency of the "typical" appearance in PCR-positive hospitalised cases and that of those in the PCR-negative hospitalised cases (1/36, 2.8%, P = 0.192).

CONCLUSIONS

When COVID-19 patients acquire infections while hospitalised, their chest CT images are less likely to show typical findings than those of outpatient cases. Comprehensive and careful assessments of CT findings and consideration of the possibility of concomitant infections with other pathogens and clinical information, such as underlying diseases, background lung structure, and time course of the infection, are required for the management of such cases.

Diabetes and COVID-19: Mechanism of pneumonia, treatment strategy and vaccine

As of August 5, 2021, there were about 200,000,000 global confirmed patients of COVID-19, with more than 4,250,000 deaths. The COVID-19 disease which is a tremendous public health threat, jumps unpredictably and outbreaks very quickly. The overall mortality rate of COVID-19 infection is 1%-15% but reaches up to 17-38% in older cases with chronic disorders and in intensive care unit (ICU) subjects. Diabetic patients, particularly those whose disease is not well controlled can be more susceptible to COVID-19. Although diabetes was present in 5.3%-42.3% of fatalities from COVID-19, the underlying pathophysiological mechanisms of action of novel coronavirus in diabetic patients are unknown. Based on the elevating of global prevalence, diabetes is the main medical problem associated with COVID-19. It is plausible that diabetes can forecast elevated severity of pneumonia. The mortality of lung infection among diabetes is remarkably higher compared with non-diabetic patients. Mechanisms responsible for severe pneumonia in the diabetic patients as well as treatment of diabetic patients infected with COVID-19 are largely speculative. Hence, this paper will summarize the recent findings related to the mechanisms of pneumonia and treatment strategies in diabetic patients.

Descriptive Analysis of Chest Computed Tomography Scan in Coronavirus Disease 2019 Pneumonia: Correlation with Reverse Transcription-polymerase Chain Reaction and Clinical Features

BACKGROUND: Reverse transcriptase-polymerase chain reaction (RT-PCR) is the primary diagnostic tool to confirm coronavirus disease 2019 (COVID-2019) due to its high specificity. However, it has relatively low sensitivity and time consuming. In contrast, chest computed tomography (CT) has high sensitivity and achieves quick results. It may, therefore, play a critical role in screening and diagnosing COVID-19. A cross-sectional study was done in 212 patients with confirmed cases and patients under surveillance for COVID-19 tested for RT-PCR and chest CT scan. Statistical analysis was performed using SPSS Version 23 (Statistical Package for the Social Sciences, IBM Corp., Armonk, NY, USA). AIM: We aim to investigate the diagnostic value of chest CT in correlation to RT-PCR in Indonesia. METHODS: A cross-sectional study was done in 212 patients with confirmed cases and patients under surveillance for COVID-19 tested for RT-PCR and chest CT scan. Statistical analysis was performed using SPSS Version 23 (Statistical Package for the Social Sciences, IBM Corp., Armonk, NY, USA). RESULTS: From a total of 212 patients, 92% of them were diagnosed as confirmed cases of COVID-19. It was found that the sensitivity of CT scan for COVID-19 patients was 72.3% (65.5% and 78.5%) with positive predictive value (PPV) of 93.9% (90.9% and 96.0%) and the sensitivity and PPV improve in symptomatic patients. Typical chest CT scan lesions were 8.0 times which were more likely (3.9–16.4; p <0.001) to be detected in symptomatic patients while patients with severe CT scan findings were 4.4 times more likely (3.0–6.5; p <0.001) to be admitted to the intensive care unit. CONCLUSION: A high PPV suggests that a chest CT scan can detect COVID-19 lesions, but the absence of the lesions would not exclude the disease’s presence.

COVID-19 and pulmonary tuberculosis - A diagnostic dilemma

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Meanwhile, pulmonary tuberculosis(TB) is one of the most common infective lung diseases in developing nations. The concurrence of pulmonary TB and COVID-19 can lead to poor prognosis, owing to the pre-existing lung damage caused by TB. Case presentation: We describe the imaging findings in 3 cases of COVID-19 pneumonia with co-existing pulmonary TB on HRCT thorax. The concurrence of COVID-19 and pulmonary TB can be a diagnostic dilemma. Correct diagnosis and prompt management is imperative to reduce mortality and morbidity. Hence it is pertinent for imaging departments to identify and report these distinct entities when presenting in conjunction.

Various theranostics and immunization strategies based on nanotechnology against Covid-19 pandemic: An interdisciplinary view

COVID-19 pandemic is still a major risk to human civilization. Besides the global immunization policy, more than five lac new cases are documented everyday. Some countries newly implement partial/complete nationwid lockdown to mitigate recurrent community spreading. To avoid the new modified stain of SARS-CoV-2 spreading, some countries imposed any restriction on the movement of the citizens within or outside the country. Effective economical point of care diagnostic and therapeutic strategy is vigorously required to mitigate viral spread. Besides struggling with repurposed medicines, new engineered materials with multiple unique efficacies and specific antiviral potency against SARS-CoV-2 infection may be fruitful to save more lives. Nanotechnology-based engineering strategy sophisticated medicine with specific, effective and nonhazardous delivery mechanism for available repurposed antivirals as well as remedial for associated diseases due to malfeasance in immuno-system e.g. hypercytokinaemia, acute respiratory distress syndrome. This review will talk about gloomy but critical areas for nanoscientists to intervene and will showcase about the different laboratory diagnostic, prognostic strategies and their mode of actions. In addition, we speak about SARS-CoV-2 pathophysiology, pathogenicity and host specific interation with special emphasis on altered immuno-system and also perceptualized, copious ways to design prophylactic nanomedicines and next-generation vaccines based on recent findings.

Evaluation of the Risk of Clinical Deterioration among Inpatients with COVID-19

This study aims to assess the risk of severe forms of COVID-19, based on clinical, laboratory, and imaging markers in patients initially admitted to the ward. This is a retrospective observational study, with data from electronic medical records of inpatients, with laboratory confirmation of COVID-19, between March and September 2020, in a hospital from Juiz de Fora-MG, Brazil. Participants (n = 74) were separated into two groups by clinical evolution: those who remained in the ward and those who progressed to the ICU. Mann-Whitney U test was taken for continuous variables and the chi-square test or Fisher's exact test for categorical variables. Comparing the proposed groups, lower values of lymphocytes (p = <0.001) and increases in serum creatinine (p = 0.009), LDH (p = 0.057), troponin (p = 0.018), IL-6 (p = 0.053), complement C4 (p = 0.040), and CRP (p = 0.053) showed significant differences or statistical tendency for clinical deterioration. The average age of the groups was 47.9 ± 16.5 and 66.5 ± 7.3 years (p = 0.001). Hypertension (p = 0.064), heart disease (p = 0.048), and COPD (p = 0.039) were more linked to ICU admission, as well as the presence of tachypnea on admission (p = 0.051). Ground-glass involvement >25% of the lung parenchyma or pleural effusion on chest CT showed association with evolution to ICU (p = 0.027), as well as bilateral opacifications (p = 0.030) when compared to unilateral ones. Laboratory, clinical, and imaging markers may have significant relation with worse outcomes and the need for intensive treatment, being helpful as predictive factors.

Importance of hyperglycemia in COVID-19 intensive-care patients: Mechanism and treatment strategy

This review reported that coronavirus disease 2019 (COVID-19) infected patients with short time bed rest or quarantine and airway inflammation are at more risk of developing hyperglycemia and insulin resistance. This condition can induce oxidative stress, decrease immune system function, impair endothelial function, induce apoptosis, and reduce antioxidant in the lungs. We provide a possible mechanism in severe COVID-19 patients and recommend treatment strategy to reduce mortality rate and prevent adverse outcomes after intensive care unit (ICU).

Recent advances and challenges of RT-PCR tests for the diagnosis of COVID-19

Since the outbreak of the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the control of virus spread has remained challenging given the pitfalls of the current diagnostic tests. Nevertheless, RNA amplification techniques have been the gold standard among other diagnostic methods for monitoring clinical samples for the presence of the virus. In the current paper, we review the shortcomings and strengths of RT-PCR (real-time polymerase chain reaction) techniques for diagnosis of coronavirus disease (COVID)-19. We address the repercussions of false-negative and false-positive rates encountered in the test, summarize approaches to improve the overall sensitivity of this method. We discuss the barriers to the widespread use of the RT-PCR test, and some technical advances, such as RT-LAMP (reverse-transcriptase-loop mediated isothermal amplification). We also address how other molecular techniques, such as immunodiagnostic tests can be used to avoid incorrect interpretation of RT-PCR tests.

Cytotoxic T-lymphocyte elicited vaccine against SARS-CoV-2 employing immunoinformatics framework

Development of effective counteragents against the novel coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strains, requires clear insights and information for understanding the immune responses associated with it. This global pandemic has pushed the healthcare system and restricted the movement of people and succumbing of the available therapeutics utterly warrants the development of a potential vaccine to contest the deadly situation. In the present study, highly efficacious, immunodominant cytotoxic T-lymphocyte (CTL) epitopes were predicted by advanced immunoinformatics assays using the spike glycoprotein of SARS-CoV2, generating a robust and specific immune response with convincing immunological parameters (Antigenicity, TAP affinity, MHC binder) engendering an efficient viral vaccine. The molecular docking studies show strong binding of the CTL construct with MHC-1 and host membrane specific TLR2 receptors. The molecular dynamics simulation in an explicit system confirmed the stable and robust binding of CTL epitope with TLR2. Steep magnitude RMSD variation and compelling residual fluctuations existed in terminal residues and various loops of the β linker segments of TLR2-epitope (residues 105-156 and 239-254) to about 0.4 nm. The reduced R_g value (3.3 nm) and stagnant SASA analysis (275 nm/S²/N after 8 ns and 5 ns) for protein surface and its orientation in the exposed and buried regions suggests more compactness due to the strong binding interaction of the epitope. The CTL vaccine candidate establishes a high capability to elicit the critical immune regulators, like T-cells and memory cells as proven by the in silico immunization assays and can be further corroborated through in vitro and in vivo assays.

Functional and Structural Characterization of SARS-Cov-2 Spike Protein: An In Silico Study

BACKGROUND

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of the global outbreak of coronavirus disease 2019 (Covid-19), which has been considered as a pandemic by WHO. SARS-CoV-2 encodes four major structural proteins, among which spike protein has always been a main target for new vaccine studies. This in silico study aimed to investigate some physicochemical, functional, immunological, and structural features of spike protein using several bioinformatics tools.

METHOD

We retrieved all SARS-CoV-2 spike protein sequences from different countries registered in NCBI GenBank. CLC Sequence Viewer was employed to translate and align the sequences, and several programs were utilized to predict B-cell epitopes. Modification sites such as phosphorylation, glycosylation, and disulfide bonds were defined. Secondary and tertiary structures of all sequences were further computed.

RESULTS

Some mutations were determined, where only one (D614G) had a high prevalence. The mutations did not impact the B-cell and physicochemical properties of the spike protein. Seven disulfide bonds were specified and also predicted in several N-link glycosylation and phosphorylation sites. The results also indicated that spike protein is a non-allergen.

CONCLUSION

In summary, our findings provided a deep understanding of spike protein, which can be valuable for future studies on SARS-CoV-2 infections and design of new vaccines.

COVID-19 fatality prediction in people with diabetes and prediabetes using a simple score upon hospital admission

AIM

To assess predictors of in-hospital mortality in people with prediabetes and diabetes hospitalized for COVID-19 infection and to develop a risk score for identifying those at the greatest risk of a fatal outcome.

MATERIALS AND METHODS

A combined prospective and retrospective, multicentre, cohort study was conducted at 10 sites in Austria in 247 people with diabetes or newly diagnosed prediabetes who were hospitalized with COVID-19. The primary outcome was in-hospital mortality and the predictor variables upon admission included clinical data, co-morbidities of diabetes or laboratory data. Logistic regression analyses were performed to identify significant predictors and to develop a risk score for in-hospital mortality.

RESULTS

The mean age of people hospitalized (n = 238) for COVID-19 was 71.1 ± 12.9 years, 63.6% were males, 75.6% had type 2 diabetes, 4.6% had type 1 diabetes and 19.8% had prediabetes. The mean duration of hospital stay was 18 ± 16 days, 23.9% required ventilation therapy and 24.4% died in the hospital. The mortality rate in people with diabetes was numerically higher (26.7%) compared with those with prediabetes (14.9%) but without statistical significance (P = .128). A score including age, arterial occlusive disease, C-reactive protein, estimated glomerular filtration rate and aspartate aminotransferase levels at admission predicted in-hospital mortality with a C-statistic of 0.889 (95% CI: 0.837-0.941) and calibration of 1.000 (P = .909).

CONCLUSIONS

The in-hospital mortality for COVID-19 was high in people with diabetes but not significantly different to the risk in people with prediabetes. A risk score using five routinely available patient variables showed excellent predictive performance for assessing in-hospital mortality.

COVID-19 – the challenge to treat a disease and not a positive RT-PCR test

The new pandemic disease COVID is quick spread worldwide.The primary method used for diagnosing of COVID-19 is detecting viral nucleic acids. The main problem with RT-PCR test is the false negative results. The negative RT-PCR does not exclude a SARS-CoV-2 infection and this method should not be used as the only diagnostic criteria. The RT-PCR result does not change the complex treatment of the disease. The aim of the current study is to compare the four groups clinical cases of the different parameters: RT-PCR test, rapid test, clinical picture, laboratory tests as hematology, inflammatory markers, coagulation status and chemistry and imaging examinations: Chest X-ray at and Chest CT scan. Complex therapeutic approach has been implemented: antibiotic, inflammatory, anticoagulants, oxygen therapy, hepatoprotectors, antimycotics, fibrinolytics, probiotics, essential oils, vitamins. During the follow-up period, a tendency for significant reduction and resorption of the pulmonary changes on the CT scans has been seen.

Hypercoagulopathy in Severe COVID-19: Implications for Acute Care

COVID-19 was first described in late 2019 and has since developed into a pandemic affecting more than 21 million people worldwide. Of particular relevance for acute care is the occurrence of COVID-19-associated coagulopathy (CAC), which is characterised by hypercoagulability, immunothrombosis and venous thromboembolism, and contributes to hypoxia in a significant proportion of patients. This review describes diagnosis and treatment of CAC in the emergency department and in intensive care. We summarise the pathological mechanisms and common complications of CAC such as pulmonary thrombosis and venous thromboembolic events and discuss current strategies for thromboprophylaxis and therapeutic anti-coagulation in the acute care setting.

Nanotechnology-Based Approaches for the Detection of SARS-CoV-2

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as a pandemic has been validated as an extreme clinical calamity and has affected several socio-economic activities globally. Proven transmission of this virus occurs through airborne droplets from an infected person. The recent upsurge in the number of infected individuals has already exceeded the number of intensive care beds available to patients. These extraordinary circumstances have elicited the need for the development of diagnostic tools for the detection of the virus and, hence, prevent the spread of the disease. Early diagnosis and effective immediate treatment can reduce and prevent an increase in the number of cases. Conventional methods of detection such as quantitative real-time polymerase chain reaction and chest computed tomography scans have been used extensively for diagnostic purposes. However, these present several challenges, including prolonged assay requirements, labor-intensive testing, low sensitivity, and unavailability of these resources in remote locations. Such challenges urgently require fast, sensitive, and accurate diagnostic techniques for the timely detection and treatment of coronavirus disease 2019 (COVID-19) infections. Point-of-care biosensors that include paper- and chip-based diagnostic systems are rapid, cost-effective, and user friendly. In this article nanotechnology-based potential biosensors for SARS-CoV-2 diagnosis are discussed with particular emphasis on a lateral flow assay, a surface-enhanced Raman scattering-based biosensor, a localized surface plasmon resonance-based biosensor, Förster resonance energy transfer, an electrochemical biosensor, and artificial intelligence-based biosensors. Several biomolecules, such as nucleic acids, antibodies/enzymes, or aptamers, can serve as potential detection molecules on an appropriate platform, such as graphene oxide, nanoparticles, or quantum dots. An effective biosensor can be developed by using appropriate combinations of nanomaterials and technologies.