2019 novel coronavirus of pneumonia in Wuhan, China: emerging attack and management strategies

Core capabilities of Chinese centers for disease control and prevention public health personnel: a network analysis from Northeast China

BACKGROUND

The COVID-19 pandemic has highlighted the continued inadequacy of the capability of Center for Disease Control and Prevention (CDC) public health personnel to respond effectively to emerging infectious disease outbreaks, as well as the urgent need for specific tools to assess the capability needed by CDC public health personnel in the post-pandemic era. Using network analysis, we aimed to analyze the comprehensive capacities of CDC public health staff and the relationships between these capacities. We also examined the impact of standardized public health training on their capacities and provided actionable recommendations for improving their training and overall capability.

METHODS

This study employs a cross-sectional design. A self-developed questionnaire was used to evaluate the capabilities of public health personnel in CDC. Network analysis was conducted using the qgraph package in R (version 4.3.1) to construct a capability network model, while the bootnet package ensured the stability and reliability of the network through bootstrapping. The NetworkComparisonTest package was applied to compare network structures and identify differences between groups.

RESULTS

Over half (51.80%, N = 11,912) of public health personnel rated their comprehensive capabilities as poor. Core capabilities, including research, motivation, and emergency response, were identified as pivotal within the capability network. The network stability coefficient for strength was 0.75, indicating reliable results. The capability networks of those who participated in standardized training differed significantly from those who did not (P = 0.04).

CONCLUSION

CDC public health personnel exhibit significant capability gaps, particularly in research and leadership. Standardized training provides some benefits but remains insufficient. Policymakers should address these gaps by aligning training content with critical capability needs, offering flexible and targeted training methods (e.g., virtual courses, self-paced modules), and implementing capability-based assessments to evaluate training outcomes.

The Relation Between Fear of COVID-19, Burnout Levels of Intensive Care Nurses

We aimed to examine the relation between the fear of COVID-19 and depression, anxiety and burnout of intensive carenurses. This cross-sectional and descriptive research was conducted with 116 intensive care nurses. The data were obtained with a web-based questionnaire created with the "Descriptive Information Form", "COVID-19 Fear Scale", "Depression, Anxiety and Stress Scale Short Form" and "Burnout Short Version". A significant positive correlation was found between depression (r = 0.498, p < .001), anxiety (r = 0.633, p < .001), stress (r = 0.589, p < .001) and burnout (r = 0.299, p = .001) levels of intensive care nurses with a mean age of 30.18 ± 6.55 with the help of the "COVID-19 Fear Scale". It was determined that the mental health of intensive care nurses was at risk and they reached the level of burnout. Intensive care nurses should be supported in understanding the symptoms of psychological problems and in stress management, personal and professional self-care. Receiving professional mental health support when necessary.

"Internet+" pharmacy in psychiatric hospital amid COVID-19 and post-pandemic period: analysis and development

Objective

This study aims to explore the differences in "Internet+" pharmacy prescriptions in psychiatric hospitals before and after the outbreak of the coronavirus disease 2019 (COVID-19) pandemic. It also seeks to examine changes in patient healthcare behaviors in the post-pandemic era and to identify the potential role of "Internet+" pharmacy in improving the current healthcare system.

Methods

Prescriptions from the "Internet+" pharmacy at The Affiliated Mental Health Center of Jiangnan University, collected between December 1, 2021, and November 30, 2023, were analyzed. The period was divided into four stages based on the COVID-19 pandemic's progression in China. Descriptive statistical analysis was conducted on various prescription-related factors, including patient information, prescription type, disease distribution, medication type, frequency of medication use, pharmacist review time, and instances of irrational medication use.

Results

A total of 2914 prescriptions were collected. The male-to-female ratio (MFR) varied significantly across different stages of the epidemic. In the pre-pandemic II period, females represented the highest proportion (66.10%, MFR 0.51), and individuals aged 18-39 made up the majority (56.70%) across all stages. The proportion of psycho-counseling prescriptions was highest in the pre-pandemic II period (76.74%), while the total number of psycho-counseling prescriptions was greatest during the epidemic, with 798 cases. A total of 38 diseases were involved, with depression accounting for the largest proportion (38.98%) at each stage, followed by the highest usage of antidepressants (49.60%). A total of 85 types of medications were used, with quetiapine representing the highest proportion before the epidemic (16.56%, 10.92%), while escitalopram accounted for the highest proportion after the epidemic (10.98%). The majority of patients (70.87%) took medication once daily. 42.23% of pharmacist review times were ≤1 minute, and the mean review time was longest in the post-pandemic period (6175.1 seconds). During the pre-pandemic and epidemic periods, the most common pharmacist review time occurred between 12:00 and 17:59 (41.46%), while in the post-pandemic period, the most common review time was between 18:00 and 23:59 (36.70%). The initial rate of irrational prescriptions was 37.85%. After manual review by pharmacists, the irrational prescription rate of Internet prescriptions decreased to 1.13%.

Conclusion

The development of "Internet+" pharmacy has effectively addressed the medical needs of the relevant population and played a crucial role in combating the COVID-19 pandemic. Future advancements should focus on optimizing the allocation of healthcare resources and expanding innovative pharmacy services to broaden the developmental pathways of the 'Internet+' pharmacy ecosystem.

Relationship between COVID-19 Cases and Environmental Contaminants in Quito, Ecuador

The relationship between COVID-19 infections and environmental contaminants provides insight into how environmental factors can influence the spread of infectious diseases. By integrating epidemiological and environmental variables into a mathematical framework, the interaction between virus spread and the environment can be determined. The aim of this study was to evaluate the impact of atmospheric contaminants on the increase in COVID-19 infections in the city of Quito through the application of statistical tests. The data on infections and deaths allowed to identify the periods of greatest contagion and their relationship with the contaminants O3, SO2, CO, PM2.5, and PM10. A validated database was used, and statistical analysis was applied through five models based on simple linear regression. The models showed a significant relationship between SO2 and the increase in infections. In addition, a moderate correlation was shown with PM2.5, O3, and CO, and a low relationship was shown for PM10. These findings highlight the importance of having policies that guarantee air quality as a key factor in maintaining people's health and preventing the proliferation of viral and infectious diseases.

A novel deterioration prediction system for mild COVID-19 patients in Korea: a retrospective study

The ongoing coronavirus disease 2019 (COVID-19) pandemic presents serious public health threats. Omicron, the current most prevalent strain of COVID-19, has a low fatality rate and very high transmissibility, so the number of patients with mild symptoms of COVID-19 is rapidly increasing. This change of pandemic challenges medical systems worldwide in many aspects, including sharp increases in demands for hospital infrastructure, critical shortages in medical equipment, and medical staff. Predicting deterioration in mild patients could alleviate these problems. A novel scoring system was proposed for predicting the deterioration of patients whose condition may worsen rapidly and those who all still mild or asymptomatic. Retrospective cohorts of 954 and 2,035 patients that quarantined in the Residential Treatment Center were assembled for derivation and external validation of mild COVID-19, respectively. Deterioration was defined as transfer to a local hospital due to worsening condition of the patients during the 2-week isolation period. A total of 15 variables: sex, age, seven pre-existing conditions (diabetes, hypertension, cardiovascular disease, respiratory disease, liver disease, kidney disease, and organ transplant), and five vital signs (systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), body temperature, and oxygen saturation (SpO2)) were collected. A scoring system was developed using seven variables (age, pulse rate, SpO2, SBP, DBP, temperature, and hypertension) with significant differences between the transfer and not transfer groups in logistic regression. The proposed system was compared with existing scoring systems that assess the severity of patient conditions. The performance of the proposed scoring system to predict deterioration in patients with mild COVID-19 showed an area under the receiver operating characteristic (AUC) of 0.868. This is a statistically significant improvement compared to the performance of the previous patient condition assessment scoring systems. During external validation, the proposed system showed the best and most robust predictive performance (AUC = 0.768; accuracy = 0.899). In conclusion, we proposed a novel scoring system for predicting patients with mild COVID-19 who will experience deterioration which could predict the deterioration of the patient's condition early with high predictive performance. Furthermore, because the scoring system does not require special calculations, it can be easily measured to predict the deterioration of a patients' condition. This system can be used as effective tool for early detection of deterioration in mild COVID-19 patients.

Factors influencing healthcare workers' and health system preparedness for the COVID-19 pandemic: A qualitative study in Ghana

Adequate preparedness of health systems, particularly healthcare workers (HCWs), to respond to COVID-19 is critical for the effective control of the virus, especially in low- and middle-income countries where health systems are overburdened. We examined Ghanaian HCWs' perceived preparedness to respond to the pandemic and the factors that shaped their preparedness and that of the health system. Semi-structured in-depth interviews were conducted with n = 26 HCWs responsible for the clinical management of COVID-19 patients and three administrators responsible for developing and implementing COVID-19 policies at the facility level. Interviews were conducted over the phone in English, transcribed, and analyzed using a thematic analysis approach. Generally, HCWs felt inadequately prepared to contain the spread of COVID-19 due to resource shortages and inadequate training. HCWs, similarly, perceived the health system to be unprepared due to insufficient clinical infrastructure and logistical challenges. The few who felt prepared identified readiness in managing high consequence infectious disease cases and pre-existing protocols as enablers of HCW preparedness. The health system and HCWs were unprepared to manage the COVID-19 pandemic due to inadequate training, logistical challenges, and weak clinical infrastructure. Interventions are urgently needed to improve the health system's preparedness for future pandemics.

Identifying plant-derived antiviral alkaloids as dual inhibitors of SARS-CoV-2 main protease and spike glycoprotein through computational screening

COVID-19 is currently considered the ninth-deadliest pandemic, spreading through direct or indirect contact with infected individuals. It has imposed a consistent strain on both the financial and healthcare resources of many countries. To address this challenge, there is a pressing need for the development of new potential therapeutic agents for the treatment of this disease. To identify potential antiviral agents as novel dual inhibitors of SARS-CoV-2, we retrieved 404 alkaloids from 12 selected medicinal antiviral plants and virtually screened them against the renowned catalytic sites and favorable interacting residues of two essential proteins of SARS-CoV-2, namely, the main protease and spike glycoprotein. Based on docking scores, 12 metabolites with dual inhibitory potential were subjected to drug-likeness, bioactivity scores, and drug-like ability analyses. These analyses included the ligand-receptor stability and interactions at the potential active sites of target proteins, which were analyzed and confirmed through molecular dynamic simulations of the three lead metabolites. We also conducted a detailed binding free energy analysis of pivotal SARS-CoV-2 protein inhibitors using molecular mechanics techniques to reveal their interaction dynamics and stability. Overall, our results demonstrated that 12 alkaloids, namely, adouetine Y, evodiamide C, ergosine, hayatinine, (+)-homoaromoline, isatithioetherin C, N,alpha-L-rhamnopyranosyl vincosamide, pelosine, reserpine, toddalidimerine, toddayanis, and zanthocadinanine, are shortlisted as metabolites based on their interactions with target proteins. All 12 lead metabolites exhibited a higher unbound fraction and therefore greater distribution compared with the standards. Particularly, adouetine Y demonstrated high docking scores but exhibited a nonspontaneous binding profile. In contrast, ergosine and evodiamide C showed favorable binding interactions and superior stability in molecular dynamics simulations. Ergosine demonstrated exceptional performance in several key pharmaceutical metrics. Pharmacokinetic evaluations revealed that ergosine exhibited pronounced bioactivity, good absorption, and optimal bioavailability. Additionally, it was predicted not to cause skin sensitivity and was found to be non-hepatotoxic. Importantly, ergosine and evodiamide C emerged as superior drug candidates for dual inhibition of SARS-CoV-2 due to their strong binding affinity and drug-like ability, comparable to known inhibitors like N3 and molnupiravir. This study is limited by its in silico nature and demands the need for future in vitro and in vivo studies to confirm these findings.

Rate and Risk Factors of Reinfection, Recurrence, and Hospital Readmission Among SARS-Cov-2 Hospitalized Patients; a National Cohort Study

Introduction

Reinfection and hospital readmission due to COVID-19 were significant and costly during the pandemic. This study aimed to assess the rate and risk factors of SARS-Cov-2 reinfection, recurrence, and hospital readmission, by analyzing the national data registry in Iran.

Methods

This study was a retrospective cohort conducted from March 2020 to May 2021. A census method was used to consider all of the possible information in the national Medical Care Monitoring Center (MCMC) database obtained from the Ministry of Health and Medical Education; the data included information from all confirmed COVID-19 patients who were hospitalized and diagnosed using at least one positive Polymerase Chain Reaction (PCR) test by nasopharyngeal swab specimens. Univariate and multivariable Cox regression analyses were performed to assess the factors related to each studied outcome.

Results

After analyzing data from 1,445,441 patients who had been hospitalized due to COVID-19 in Iran, the rates of overall reinfection, reinfection occurring at least 90 days after the initial infection, recurrence, and hospital readmission among hospitalized patients were 67.79, 26.8, 41.61, and 30.53 per 1000 person-years, respectively. Among all cases of hospitalized reinfection (48292 cases), 38.61% occurred more than 90 days from the initial SARS-Cov-2 infection. Getting infected with COVID-19 in the fifth wave of the disease compared to getting infected in the first wave (P<0.001), having cancer (P<0.001), chronic kidney disease (P<0.001), and age over 80 years (P<0.001) were respectively the most important risk factors for overall reinfection. In contrast, age 19-44 years (P<0.001), intubation (P<0.001), fever (P<0.001), and cough (P<0.001) in the initial admission were the most important protective factors of overall reinfection, respectively.

Conclusion

Reinfection and recurrence of COVID-19 after recovery and the rate of hospital readmission after discharge were remarkable. Advanced or young age, as well as having underlying conditions like cancer and chronic kidney disease, increase the risk of infection and readmission.

Molecular interactions of the Omicron, Kappa, and Delta SARS-CoV-2 spike proteins with quantum dots of graphene oxide

CONTEXT

The Omicron, Kappa, and Delta variants are different strains of the SARS-CoV-2 virus. Graphene oxide quantum dots (GOQDs) represent a burgeoning class of oxygen-enriched, zero-dimensional materials characterized by their sub-20-nm dimensions. Exhibiting pronounced quantum confinement and edge effects, GOQDs manifest exceptional physical-chemical attributes. This study delves into the potential of graphene oxide quantum dots, elucidating their inherent properties pertinent to the surface structures of SARS-CoV-2, employing an integrated computational approach for the repositioning of inhibitory agents.

METHODS

Following rigorous adjustment tests, a spectrum of divergent bonding conformations emerged, with particular emphasis placed on identifying the conformation exhibiting optimal adjustment scores and interactions. The investigation employed molecular docking simulations integrating affinity energy evaluations, electrostatic potential clouds, molecular dynamics encompassing average square root calculations, and the computation of Gibbs-free energy. These values quantify the strength of interaction between GOQDs and SARS-CoV-2 spike protein variants. The receptor structures were optimized using the CHARM-GUI server employing force field AMBERFF14SB. The algorithm embedded in CHARMM offers an efficient interpolation scheme and automatic step size selection, enhancing the efficiency of the optimization process. The 3D structures of the ligands are constructed and optimized with density functional theory (DFT) method based on the most stable conformer of each binder. Autodock Vina Software (ADV) was utilized, where essential parameters were specified. Electrostatic potential maps (MEPs) provide a visual depiction of molecules' charge distributions and related properties. After this, molecular dynamics simulations employing the CHARM36 force field in Gromacs 2022.2 were conducted to investigate GOs' interactions with surface macromolecules of SARS-CoV-2 in an explicit aqueous environment. Furthermore, our investigation suggests that lower values indicate stronger binding. Notably, GO-E consistently showed the most negative values across interactions with different variants, suggesting a higher affinity compared to other GOQDs (GO-A to GO-D).

ELANE rs17223045C/T and rs3761007G/A variants: Protective factors against COVID-19

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for causing coronavirus disease 2019 (COVID-19). The development and severity of this infectious disease is influenced by a combination of environmental and genetic factors. Angiotensin-converting enzyme 2 (ACE2) facilitates SARS-CoV-2 entry into human cells, with transmembrane serine protease 2 (TMPRSS2) playing a crucial role in S protein priming. Other proteases, such as cathepsin L and elastase, neutrophil-expressed (ELANE), have the capability to prime the S protein and contribute to SARS-CoV-2 infection. ELANE variants have not been previously examined in COVID-19 patients. We aimed to assess the association of single nucleotide variants (SNVs) within ELANE with COVID-19 and biochemical markers. The study included 319 SARS-CoV-2-infected patients and 288 controls. Genotyping of ELANE rs17216663C/T (Pro257Leu), rs17223045C/T (As1n30Asn), and rs3761007G/A was conducted using a 5'-nuclease allelic discrimination assay (TaqMan assay). Our findings indicate that ELANE rs17223045C/T (C vs T: odds ratio [OR] 0.08, P = 0.005, and CC vs CT: OR 0.08, P = 0.005) and rs3761007G/A (G vs A: OR 0.38, P = 0.009, and GG vs GA: OR 0.40, P = 0.008) confer protection against COVID-19. However, these variants were not associated with biochemical markers. In conclusion, our data suggests that ELANE rs17223045C/T and rs3761007G/A SNVs may play a protective role against COVID-19.

Knowledge, Attitudes and Practices of Pediatricians About COVID-19 Vaccination to Children

Objectives

Achieving high vaccination rates is very important in the prevention of the coronavirus disease 2019 (COVID-19) as in other infectious diseases. This study aimed to evaluate pediatricians' knowledge, attitudes and behaviours about COVID-19 vaccination of children.

Methods

Our single-center, descriptive, cross-sectional, prospective study was conducted between September 20, 2022 and November 30, 2022. The sample consisted of 350 physicians who agreed to fill out the questionnaire voluntarily. Participants were asked 21 questions about their sociodemographic data, knowledge about COVID-19 vaccination of children, attitudes and behaviours via Google Forms.

Results

A total of 350 pediatricians, 72.6% of whom were women, participated in our study. 51.4% of the participants were working in a Training and Research Hospital, and 99.1% had received COVID-19 vaccination themselves. While 65.7% (n=230) of pediatricians recommended COVID-19 vaccination for all children, 27.7% (n=97) recommended it only for children in the risk group, and 6.6% (n=23) did not recommend COVID-19 vaccination for children. The most common reasons why pediatricians did not recommend the vaccine to all children were; 56.7% lack of sufficient clinical research on vaccination in children, 50% concerns about the long-term effects of the vaccine, 27.5% vaccine-related side effects. The most risk groups for which participants recommended vaccination were asthma (chronic lung disease) 84.6%, diabetes mellitus 72%, and immunodeficiency 69.7%. 68.9% of pediatricians knew that COVID-19 vaccine was used for children aged 12 years and older in Türkiye, and 60.9% thought that COVID-19 vaccine was safe for children. Those who thought that COVID-19 vaccine was safe for children were more likely to recommend the vaccine to children (p<0.001). When the answers given to the knowledge questions were analyzed, it was found that the knowledge level of those who did not recommend vaccination to children was lower than the others (p<0.001).

Conclusion

In the present study, pediatricians mostly recommend COVID-19 vaccine to children. The vaccine safety and the level of knowledge about COVID-19 vaccine are effective factors in recommending the vaccine. Therefore, we conclude that trainings to be organized for pediatricians about COVID-19 vaccine will increase the rate of recommending COVID-19 vaccine to children.

Public Perception Toward the Malaysian National COVID-19 Immunisation Programme (PICK) in the State of Sabah, Malaysia: A Cross-Sectional Survey

The Malaysian Government has initiated the National COVID-19 Immunisation Programme, known as PICK, to be a national strategy for addressing the spread of the coronavirus disease (COVID-19) pandemic across the country. Although the government intensified public awareness to increase program registration, the total number that registered in the state of Sabah, located in East Malaysia, was relatively low during August 2021, accounting for only 42.9% as compared to that of Peninsular Malaysia. Therefore, this paper examines the public perception toward the PICK program in Sabah based on 4 main components: safety, communication, psychology, and milieu. This study is based on the empirical findings drawn from 1024 respondents across Sabah using online Google Form surveys. This study adopts 5 methodologies for data analysis by using K-means clustering, mean score, Mann-Whitney U test, spatial analysis, and frequency analysis. It has been revealed that the percentage of respondents (categorized as Cluster 1) who have a negative perception toward the vaccination program is higher (55.9%) than those who have a positive perception (44.1%). This study further discovered that Cluster 1 has shown high skepticism regarding the vaccination program, which can be explained through the communication component (M = 3.33, SD = 0.588), especially Co2, Co3, Co1, and Co4. Following the communication factor, a chain of negative perceptions also affects other components such as safety, psychology, and milieu among Cluster 1, all of which contribute to poor participation in the PICK program. The study outcomes are extremely useful for informing local authorities to establish policies related to public interests, primarily in the areas of public health. Understanding the community's perspectives and their obstacles in participating in such programs may assist local authorities in developing or implementing public policies and campaigns that ensure such related public programs can be conducted more effectively in the future.

Evaluations of FDA-approved Drugs Targeting 3CLP of SARS-CoV-2 Employing a Repurposing Strategy

BACKGROUND

The SARS-CoV-2 coronavirus (COVID-19) has raised innumerable global concerns, and few effective treatment strategies have yet been permitted by the FDA to lighten the disease burden. SARS-CoV-2 3C-like proteinase (3CLP) is a crucial protease and plays a key role in the viral life cycle, as it controls replication, and thus, it is viewed as a target for drug design.

METHODS

In this study, we performed structure-based virtual screening of FDA drugs approved during 2015-2019 (a total of 220 drugs) for interaction with the active site of 3CLP (PDB ID 6LU7) using AutoDock 4.2. We report the top ten drugs that outperform the reported drugs against 3CLP (Elbasvir and Nelfinavir), particularly Cefiderocol, having the highest affinity among the compounds tested, with a binding energy of -9.97 kcal/mol. H-bond (LYS102:HZ2-ligand: O49), hydrophobic (ligand-VAL104), and electrostatic (LYS102:NZ-ligand: O50) interactions were observed in the cefiderocol-3CLP complex. The docked complex was subjected to a 50 ns molecular dynamics study to check its stability, and stable RMSD and RMSF graphs were observed.

RESULTS

Accordingly, we suggest cefiderocol might be effective against SARS-CoV-2 and urge that experimental validation be performed to determine the antiviral efficacy of cefiderocol against SARS-CoV-2.

DISCUSSION

Along with these, cefiderocol is effective for treating respiratory tract pathogens and a wide range of gram-negative bacteria for whom there are limited therapeutic alternatives.

CONCLUSION

This article aimed to explore the FDA-approved drugs as a repurposing study against 3CLP for COVID-19 management.

Circulating miRNA profiles in COVID-19 patients and meta-analysis: implications for disease progression and prognosis

We compared circulating miRNA profiles of hospitalized COVID-positive patients (n = 104), 27 with acute respiratory distress syndrome (ARDS) and age- and sex-matched healthy controls (n = 18) to identify miRNA signatures associated with COVID and COVID-induced ARDS. Meta-analysis incorporating data from published studies and our data was performed to identify a set of differentially expressed miRNAs in (1) COVID-positive patients versus healthy controls as well as (2) severe (ARDS+) COVID vs moderate COVID. Gene ontology enrichment analysis of the genes these miRNAs interact with identified terms associated with immune response, such as interferon and interleukin signaling, as well as viral genome activities associated with COVID disease and severity. Additionally, we observed downregulation of a cluster of miRNAs located on chromosome 14 (14q32) among all COVID patients. To predict COVID disease and severity, we developed machine learning models that achieved AUC scores between 0.81-0.93 for predicting disease, and between 0.71-0.81 for predicting severity, even across diverse studies with different sample types (plasma versus serum), collection methods, and library preparations. Our findings provide network and top miRNA feature insights into COVID disease progression and contribute to the development of tools for disease prognosis and management.

Severity of oxidative stress as a hallmark in COVID-19 patients

INTRODUCTION

Understanding the mechanisms and identifying effective treatments for the COVID-19 outbreak are imperative. Therefore, this study aimed to assess the antioxidant status and oxidative stress parameters as potential pivotal mechanisms in asymptomatic, non-severe, and severe COVID-19 patients.

METHODS

This study is a case-control study that was performed on patients referred to the Persian Gulf Martyrs Hospital of Bushehr University of Medical Sciences, Bushehr, Iran, from May 2021 to September 2021. A total of 600 COVID-19 patients (non-severe and severe group) and 150 healthy volunteers of the same age and sex were selected during the same period. On the first day of hospitalization, 10 ml of venous blood was taken from subjects. Then, hematological, biochemical, serological, antioxidant and oxidative stress parameters were determined.

RESULTS

Our results indicated that ESR, CRP, AST, ALT, and LDH significantly augmented in the severe group as compared to the non-severe and normal groups (P ≤ 0.05). It was observed that the levels of FRAP, G6PD activity, and SOD activity significantly reduced in the non-severe patients in comparison with the severe and normal groups (P ≤ 0.05). We found that MDA content and NO metabolite markedly increased in severe patients as compared to the non-severe group.

CONCLUSIONS

Taken together, it seems that the balance between antioxidants and oxidants was disturbed in COVID-19 patients in favor of oxidant markers. In addition, this situation caused more aggravation in severe patients as compared to the non-severe group.

Knowledge, attitude, and adherence to coronavirus preventive measures among residents of the Kingdom of Saudi Arabia

Since the SARS-CoV-2 virus, the virus that causes COVID-19, has been spreading globally, variants have emerged and been identified in many countries around the world. This descriptive cross-sectional study aimed to explore the level of knowledge, attitude, and adherence to coronavirus variant preventive measures among residents of the Kingdom of Saudi Arabia. This is a cross-sectional online survey that was conducted between April and November 2020 and involved the residents of the Kingdom of Saudi Arabia. An electronic invitation for participation was sent to prospective participants, including the link to the research instrument, using social media websites. A total of 780 participants responded to a 4-part online survey developed by the investigators. The findings revealed that 72.9% of the participants (95% CI: 69.6%-75.9%) had a high level of knowledge about COVID-19; 78.2% said they supported all precautionary measures put in place by health authorities; only 29% wore face masks; and 93% wash their hands at least 5 times a day. Furthermore, 69% of the residents were always covering their mouth and nose when coughing or sneezing with a piece of tissue paper, while 71% were observing physical distancing. Participants showed a positive attitude towards supporting all the precautionary measures being put in place by the health authorities and the efforts made by healthcare workers in the kingdom. Residents in Saudi Arabia showed a high level of knowledge of COVID-19 variants. Higher levels of education, being employed, and higher income were factors that influenced participants' knowledge positively (P < .05). Females and younger age were predictors of a better attitude towards COVID-19 (P < .01).The majority of the residents were afraid of the spread and mutation of the coronavirus. This study highlights the value of continuing community service learning programs for raising knowledge retention and adherence to coronavirus variant prevention strategies.

Post COVID-19 complications and follow up biomarkers

Millions of people were infected by the coronavirus disease (COVID-19) epidemic, which left a huge burden on the care of post COVID-19 survivors around the globe. The self-reported COVID-19 symptoms were experienced by an estimated 1.3 million people in the United Kingdom (2% of the population), and these symptoms persisted for about 4 weeks from the beginning of the infection. The symptoms most frequently reported were exhaustion, shortness of breath, muscular discomfort, joint pain, headache, cough, chest pain, cognitive impairment, memory loss, anxiety, sleep difficulties, diarrhea, and a decreased sense of smell and taste in post-COVID-19 affected people. The post COVID-19 complications were frequently related to the respiratory, cardiac, nervous, psychological and musculoskeletal systems. The lungs, liver, kidneys, heart, brain and other organs had been impaired by hypoxia and inflammation in post COVID-19 individuals. The upregulation of substance "P" (SP) and various cytokines such as tumor necrosis factor-alpha (TNF-α), interleukin 6 (IL-6), interleukin 10 (IL-10), interleukin 1 beta (IL-1β), angiotensin-converting enzyme 2 (ACE2) and chemokine C-C motif ligand 3 (CCL3) has muddled respiratory, cardiac, neuropsychiatric, dermatological, endocrine, musculoskeletal, gastrointestinal, renal and genitourinary complications in post COVID-19 people. To prevent these complications from worsening, it was therefore important to study how these biomarkers were upregulated and block their receptors.

Facing the Challenges in the COVID-19 Pandemic Era: From Standard Treatments to the Umbilical Cord-Derived Mesenchymal Stromal Cells as a New Therapeutic Strategy

Coronavirus disease 2019 (COVID-19), the pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which counts more than 650 million cases and more than 6.6 million of deaths worldwide, affects the respiratory system with typical symptoms such as fever, cough, sore throat, acute respiratory distress syndrome (ARDS), and fatigue. Other nonpulmonary manifestations are related with abnormal inflammatory response, the "cytokine storm", that could lead to a multiorgan disease and to death. Evolution of effective vaccines against SARS-CoV-2 provided multiple options to prevent the infection, but the treatment of the severe forms remains difficult to manage. The cytokine storm is usually counteracted with standard medical care and anti-inflammatory drugs, but researchers moved forward their studies on new strategies based on cell therapy approaches. The perinatal tissues, such as placental membranes, amniotic fluid, and umbilical cord derivatives, are enriched in mesenchymal stromal cells (MSCs) that exert a well-known anti-inflammatory role, immune response modulation, and tissue repair. In this review, we focused on umbilical-cord-derived MSCs (UC-MSCs) used in in vitro and in vivo studies in order to evaluate the weakening of the severe symptoms, and on recent clinical trials from different databases, supporting the favorable potential of UC-MSCs as therapeutic strategy.

Optimization and Improvement of qPCR Detection Sensitivity of SARS-CoV-2 in Saliva

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been a major public health threat globally, especially during the beginning of the pandemic in 2020. Reverse transcription-quantitative PCR (RT-qPCR) is utilized for viral RNA detection as part of control measures to limit the spread of COVID-19. Collecting nasopharyngeal swabs for RT-qPCR is a routine diagnostic method for COVID-19 in clinical settings, but its large-scale implementation is hindered by a shortage of trained health professionals. Despite concerns over its sensitivity, saliva has been suggested as a practical alternative sampling approach to the nasopharyngeal swab for viral RNA detection. In this study, we spiked saliva from healthy donors with inactivated SARS-CoV-2 from an international standard to evaluate the effect of saliva on viral RNA detection. On average, the saliva increased the cycle threshold (CT) values of the SARS-CoV-2 RNA samples by 2.64 compared to the viral RNA in viral transport medium. Despite substantial variation among different donors in the effect of saliva on RNA quantification, the outcome of the RT-qPCR diagnosis was largely unaffected for viral RNA samples with CT values of <35 (1.55 log10 IU/mL). The saliva-treated viral RNA remained stable for up to 6 h at room temperature and 24 h at 4°C. Further supplementing protease and RNase inhibitors improved the detection of viral RNA in the saliva samples. Our data provide practical information on the storage conditions of saliva samples and suggest optimized sampling procedures for SARS-CoV-2 diagnosis. IMPORTANCE The primary method for detection of SARS-CoV-2 is using nasopharyngeal swabs, but a shortage of trained health professionals has hindered its large-scale implementation. Saliva-based nucleic acid detection is a widely adopted alternative, due to its convenience and minimally invasive nature, but the detection limit and direct impact of saliva on viral RNA remain poorly understood. To address this gap in knowledge, we used a WHO international standard to evaluate the effect of saliva on SARS-CoV-2 RNA detection. We describe the detection profile of saliva-treated SARS-CoV-2 samples under different storage temperatures and incubation periods. We also found that adding protease and RNase inhibitors could improve viral RNA detection in saliva. Our research provides practical recommendations for the optimal storage conditions and sampling procedures for saliva-based testing, which can improve the efficiency of COVID-19 testing and enhance public health responses to the pandemic.

The Experiences of COVID-19 Patients in Intensive Care Units: A Qualitative Study

This exploratory qualitative study explores the experiences of COVID-19 patients in intensive care units and after discharge. Semi- structured telephone interviews were conducted with 18 COVID-19 patients admitted to and discharged from intensive care units between March and September in 2020. The themes of this study were determined as "feelings about the illness and intensive care," "psychological and physical damages," "nurses' efforts and the importance of care.", and "protecting health and life". COVID-19 patients in intensive care units may experience permanent physical and psychological damages. The findings suggest that the first step in carrying out interventions in the intensive care units is to ensure that continuous communication with patients is maintained so that their orientation to the new circumstances can be achieved. Nursing interventions to patients missing their families can have compensated for the loss of family support and care during their critical illness.

Changes in the teaching of prosthodontics adopted in the last academic course of the degree in Dentistry in Spain during the first period of the COVID-19 pandemic

OBJECTIVES

To investigate the impact of the COVID-19 pandemic in the teaching of prosthodontics, on the 5^th course of the Bachelor's degree in Dentistry in Spain.

METHODS

In June 2021, a two-section survey was submitted to the coordinators of prosthodontics of the 23 Spanish faculties of Dentistry. The first section was focused on the theoretical lessons, seminars, and clinical discussion sessions. The second part relied on the clinical teaching and the implemented preventive measures.

RESULTS

The response rate was 100%. By the end of the 2020-21 course, both the theoretical and practical teaching were replaced by online activities, returning to face-to face in 2021-22. While most participants preferred in-person seminars and clinical discussion sessions, concerning the theory, comparable percentages of professors chose either face-to-face or blended learning (BL). The students' satisfaction with BL is high, but they seem more attentive in-person. At the beginning of the pandemic, the most common emergency in prosthodontics was debonding. Overall, a low concern about cross-infection was noticed. The barrier measures were the mainly adopted for prevention.

CONCLUSIONS

Although the BL is appreciated in prosthodontics for theoretical lessons, face-to-face teaching appears to be the best option for seminars and clinical case discussions. The students are satisfied with BL.

CLINICAL SIGNIFICANCE

In the face of the COVID-19 pandemic, the Spanish faculties of Dentistry responded quickly to continuing offering quality education through an accelerated digitization process that has created a new paradigm. Detailed analyses of these changes may help establish plans to respond systematically to unforeseen emergencies.

The efficacy and effectiveness of COVID-19 vaccines around the world: a mini-review and meta-analysis

OBJECTIVES

This meta-analysis evaluated the Efficacy and Effectiveness of several COVID-19 vaccines, including AstraZeneca, Pfizer, Moderna, Bharat, and Johnson & Johnson, to better estimate their immunogenicity, benefits, or side effects.

METHODS

Studies reporting the Efficacy and Effectiveness of COVID-19 vaccines from November 2020 to April 2022 were included. The pooled Effectiveness/Efficacy with a 95% confidence interval (95% CI) with Metaprop order was calculated. The results were presented in forest plots. Predefined subgroup analyses and sensitivity analyses were also performed.

RESULTS

A total of twenty articles were included in this meta-analysis. After the first dose of the vaccine, the total effectiveness of all COVID-19 vaccines in our study was 71% (95% CI 0.65, 0.78). The total effectiveness of vaccines after the second dose was 91% (95% CI 0.88, 0.94)). The total efficacy of vaccines after the first and second doses was 81% (95% CI 0.70, 0.91) and 71% (95% CI 0.62, 0.79), respectively. The effectiveness of the Moderna vaccine after the first and second dose was the highest among other studied vaccines ((74% (95% CI, 0.65, 0.83) and 93% (95% CI, 0.89, 0.97), respectively). The highest first dose overall effectiveness of the studied vaccines was against the Gamma variant (74% (95% CI, 0.73, 0.75)), and the highest effectiveness after the second dose was observed against the Beta variant (96% (95% CI, 0.96, 0.96)). The Efficacy for AstraZeneca and Pfizer vaccines after the first dose was 78% (95% CI, 0.62, 0.95) and 84% (95% CI, 0.77, 0.92), respectively. The second dose Efficacy for AstraZeneca, Pfizer, and Bharat was 67% (95% CI, 0.54, 0.80), 93% (95% CI, 0.85, 1.00), and 71% (95% CI, 0.61, 0.82), respectively. The overall efficacy of first and second dose vaccination against the Alfa variant was 84% (95% CI, 0.84, 0.84) and 77% (95% CI, 0.57, 0.97), respectively, the highest among other variants.

CONCLUSION

mRNA-based vaccines against COVID-19 showed the highest total efficacy and effectiveness than other vaccines. In general, administering the second dose produced a more reliable response and higher effectiveness than a single dose.

Descriptive Study to Assess Post-acute COVID-19 Complications in Patients Presenting at a Teaching Hospital in North India

Introduction Coronavirus disease 2019 (COVID-19) caused by a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported at the end of 2019 in Wuhan, Hubei Province, People's Republic of China, at a cluster of unusual pneumonia patients. The outbreak was declared a Public Health Emergency of International Concern on 30 January 2020 by World Health Organization. We are receiving patients in our OPD (Out Patient Department) with a new set of health complications having been infected with COVID-19. We planned to collect our data and try to find by various statistical methods, quantify the complications, and assess how we can deal with the new set of complications we are witnessing in this post-acute COVID-19 group of patients. Materials and methods The study was conducted by enrolling the patients at OPD/IPD (In Patient Department) by conducting a detailed history and clinical examination, routine investigations, 2D echocardiography (2D Echo), and pulmonary function test (PFT). The study assessed the worsening of symptoms, new onset symptoms, or the symptoms that continued even in the post-COVID-19 status as post-COVID-19 sequelae. Results Maximum cases were male and most of them were asymptomatic. The most common post-COVID-19 symptom that persisted was fatigue. 2D Echo and spirometry were done and changes were noticed even in those subjects who were asymptomatic. Conclusion Since significant findings were seen on clinical evaluation accompanied by 2D Echo and spirometry, it is essential to screen all presumed and microbiologically proven cases for long-term follow-up.

Factors associated with having COVID-19 among unvaccinated pregnant and non-pregnant women in Metro Manila, Philippines: a multicentre longitudinal cohort study

OBJECTIVE

To determine the potential risk factors associated with having COVID-19 among unvaccinated pregnant and non-pregnant women.

DESIGN

A multicentre prospective cohort study among eligible women in Metro Manila, Philippines, from 2020 to 2022.

SETTING

Five national and local hospital research sites altogether recruited and screened 500 consenting eligible individuals.

PARTICIPANTS

Pregnant and non-pregnant participants meeting the eligibility criteria were admitted for a reverse-transcription PCR determination of SARS-CoV-2, pregnancy testing and ultrasound, and an interview with an administered questionnaire.

EXPOSURES

Primary exposure was pregnancy; secondary exposures involve sociodemographic, lifestyle and obstetric-gynaecologic factors.

OUTCOME MEASURE

Outcome being measured was COVID-19 status.

RESULTS

The significant COVID-19 risk factors were: pregnancy (PR=1.184, 95% CI 1.096, 1.279), having a white-collar job (PR=1.123, 95% CI 1.02, 1.235), travelling abroad (PR=1.369, 95% CI 1.083, 1.173) and being infected by at least one vaccine-preventable disease (VPD) (PR=1.208, 95% CI 1.113, 1.310). Protective factors included having graduate-level education (PR=0.787, 95% CI 0.649, 0.954), immunisation against a VPD (PR=0.795, 95% CI 0.733, 0.862) and practising contraception (PR=0.889, 95% CI 0.824, 0.960).

CONCLUSION

This study is the first in the country to determine the risks influencing COVID-19 infection among unvaccinated pregnant and non-pregnant women. Pregnancy is a significant risk for COVID-19 among women in Metro Manila. Educational attainment and positive health behaviours seem to confer protection. Occupations and activities that increase the frequency of interactions, as well as history of communicable diseases may predispose women to COVID-19. Further studies are needed to elucidate the development of the disease in pregnant women, including the maternal and neonatal effects of COVID-19 via potential vertical mechanisms of transmission.

Molecular Screening of Bioactive Compounds of Garlic for Therapeutic Effects against COVID-19

An outbreak of pneumonia occurred on December 2019 in Wuhan, China, which caused a serious public health emergency by spreading around the globe. Globally, natural products are being focused on more than synthetic ones. So, keeping that in view, the current study was conducted to discover potential antiviral compounds from Allium sativum. Twenty-five phytocompounds of this plant were selected from the literature and databases including 3-(Allylsulphinyl)-L-alanine, Allicin, Diallyl sulfide, Diallyl disulfide, Diallyl trisulfide, Glutathione, L-Cysteine, S-allyl-mercapto-glutathione, Quercetin, Myricetin, Thiocysteine, Gamma-glutamyl-Lcysteine, Gamma-glutamylallyl-cysteine, Fructan, Lauricacid, Linoleicacid, Allixin, Ajoene, Diazinon Kaempferol, Levamisole, Caffeicacid, Ethyl linoleate, Scutellarein, and S-allylcysteine methyl-ester. Virtual screening of these selected ligands was carried out against drug target 3CL protease by CB-dock. Pharmacokinetic and pharmacodynamic properties defined the final destiny of compounds as drug or non-drug molecules. The best five compounds screened were Allicin, Diallyl Sulfide, Diallyl Disulfide, Diallyl Trisulfide, Ajoene, and Levamisole, which showed themselves as hit compounds. Further refining by screening filters represented Levamisole as a lead compound. All the interaction visualization analysis studies were performed using the PyMol molecular visualization tool and LigPlot+. Conclusively, Levamisole was screened as a likely antiviral compound which might be a drug candidate to treat SARS-CoV-2 in the future. Nevertheless, further research needs to be carried out to study their potential medicinal use.

Epigenetic Targets and Pathways Linked to SARS-CoV-2 Infection and Pathology

The scale at which the SARS-CoV-2/COVID-19 pandemic has spread remains enormous. Provided the genetic makeup of the virus and humans is readily available, the quest for knowing the mechanism and epidemiology continues to prevail across the entire scientific community. Several aspects, including immunology, molecular biology, and host-pathogen interaction, are continuously being dug into for preparing the human race for future pandemics. The exact reasons for vast differences in symptoms, pathophysiological implications of COVID-infections, and mortality differences remain elusive. Hence, researchers are also looking beyond traditional genomics, proteomics, and transcriptomics approach, especially entrusting the environmental regulation of the genetic landscape of COVID-human interactions. In line with these questions lies a critical process called epigenetics. The epigenetic perturbations in both host and parasites are a matter of great interest to unravel the disparities in COVID-19 mortalities and pathology. This review provides a deeper insight into current research on the epigenetic landscape of SARS-CoV-2 infection in humans and potential targets for augmenting the ongoing investigation. It also explores the potential targets, pathways, and networks associated with the epigenetic regulation of processes involved in SARS-CoV-2 pathology.

Survey on public awareness, attitudes and self-protective behavior adoption in different periods of COVID-19

Introduction

The outbreak and spread of the pandemics have been an issue of critical concern globally, posing a significant threat to the health sector globally. This study aimed to examine the basic knowledge and attitudes toward the recommended protective measures at different times, respond to the COVID-19 pandemic, and provide recommendations for developing targeted strategies and measures for preventing and controlling public health emergencies.

Methods

The study used self-filled questionnaires to examine the public's knowledge, attitudes, and practices on COVID-19 at two different period, from 20 to 31 March 2020 (the beginning period) and 22-27 April 2022 (the regular epidemic prevention and control period). Descriptive and quantitative analyses were used for statistical analysis.

Results and discussion

The survey collected 2375 valid questionnaires. A comparison of the two periods reveals that as the epidemic continued over a long period, the level of knowledge, attitudes toward preventive measures, risk perceptions, and adoption behavior of the respondents at the beginning of the epidemic were significantly higher than during the regular epidemic prevention and control period. With the upsurge in the spread of the epidemic, the public needs a multi-channel, targeted, and all-round guidance and information on prevention and control of the COVID-19, and internalizes knowledge into individual's behavior of actively responding to diseases.When the epidemic lasts for a long time, the relevant agencies should strengthen their monitoring role to promote public compliance with the recommended measures.

Structure based Drug Designing Approaches in SARS-CoV-2 Spike Inhibitor Design

The COVID-19 outbreak and the pandemic situation have hastened the research community to design a novel drug and vaccine against its causative organism, the SARS-CoV-2. The spike glycoprotein present on the surface of this pathogenic organism plays an immense role in viral entry and antigenicity. Hence, it is considered an important drug target in COVID-19 drug design. Several three-dimensional crystal structures of this SARS-CoV-2 spike protein have been identified and deposited in the Protein DataBank during the pandemic period. This accelerated the research in computer- aided drug designing, especially in the field of structure-based drug designing. This review summarizes various structure-based drug design approaches applied to this SARS-CoV-2 spike protein and its findings. Specifically, it is focused on different structure-based approaches such as molecular docking, high-throughput virtual screening, molecular dynamics simulation, drug repurposing, and target-based pharmacophore modelling and screening. These structural approaches have been applied to different ligands and datasets such as FDA-approved drugs, small molecular chemical compounds, chemical libraries, chemical databases, structural analogs, and natural compounds, which resulted in the prediction of spike inhibitors, spike-ACE-2 interface inhibitors, and allosteric inhibitors.

Chetomin, a SARS-CoV-2 3C-like Protease (3CLpro) Inhibitor: In Silico Screening, Enzyme Docking, Molecular Dynamics and Pharmacokinetics Analysis

The emergence of the Coronavirus Disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has led to over 6 million deaths. The 3C-like protease (3CLpro) enzyme of the SARS-CoV-2 virus is an attractive druggable target for exploring therapeutic drug candidates to combat COVID-19 due to its key function in viral replication. Marine natural products (MNPs) have attracted considerable attention as alternative sources of antiviral drug candidates. In looking for potential 3CLpro inhibitors, the MNP database (>14,000 molecules) was virtually screened against 3CLpro with the assistance of molecular docking computations. The performance of AutoDock and OEDocking software in anticipating the ligand-3CLpro binding mode was first validated according to the available experimental data. Based on the docking scores, the most potent MNPs were further subjected to molecular dynamics (MD) simulations, and the binding affinities of those molecules were computed using the MM-GBSA approach. According to MM-GBSA//200 ns MD simulations, chetomin (UMHMNP1403367) exhibited a higher binding affinity against 3CLpro than XF7, with ΔGbinding values of −55.5 and −43.7 kcal/mol, respectively. The steadiness and tightness of chetomin with 3CLpro were evaluated, revealing the high stabilization of chetomin (UMHMNP1403367) inside the binding pocket of 3CLpro throughout 200 ns MD simulations. The physicochemical and pharmacokinetic features of chetomin were also predicted, and the oral bioavailability of chetomin was demonstrated. Furthermore, the potentiality of chetomin analogues −namely, chetomin A-D− as 3CLpro inhibitors was investigated. These results warrant further in vivo and in vitro assays of chetomin (UMHMNP1403367) as a promising anti-COVID-19 drug candidate.

A Scoping Review on COVID-19 Vaccine Hesitancy among the Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual (LGBTQIA+) Community and Factors Fostering Its Refusal

BACKGROUND

The ramifications of the existing crisis caused by the coronavirus pandemic are sensed in all walks of life. Among the various efforts made to curb the spread of this novel infection, the development of COVID-19 vaccines had a profound role in flattening the pandemic curve. Even though the rapid vaccine drive received a highly welcoming response among people, the reluctance and ignorance of a part of the population towards available safe vaccines stand as impediments to achieving the desired outcome. The LGBTQIA+ (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual) communities are the least studied groups in this regard.

OBJECTIVE

The purpose of this study is to extensively review and report on COVID-19 vaccine uptake and refusal among the LGBTQIA+ population and enumerate the factors contributing to vaccine hesitancy. The study extends further to outline a conceptual framework for interventions to enhance COVID-19 vaccine acceptance among the LGBTQIA+ population.

METHODS

We performed a systematic search using key terms on Google Scholar and PubMed. The obtained results were filtered using the eligibility criteria framed for this study. The initial search provided an extensive result of 4510 articles which were later screened at various levels to arrive at the final inclusive collection of manuscripts adding to 17. The studies were analyzed by the authors individually, and the data were categorized using variables. The results are interpreted using charts and graphs. The whole manuscript has been structured in accordance with the PRISMA extension for scoping reviews.

RESULT

The comprehensive search yielded 17 eligible articles for this review. Most of the studies were conducted in the United States (n = 17), and predominantly cross-sectional studies have been conducted. The major comparative factor was the HIV status of the LGBTQIA+ population. HIV-affected patients were more willing to take up COVID-19 vaccination. However, social stigma, discrimination, lack of access and non-prioritization in vaccine drives were found to be the major factors contributing to vaccine hesitancy among this population.

CONCLUSION

The invention of the COVID-19 vaccination revolutionized the healthcare systems burdened with COVID-19. Although this is a breakthrough scientific contribution, many factors are associated with the rate of vaccine acceptance, especially among sexual and gender minorities. The reviewed studies have revealed numerous factors that influence vaccine uptake and refusal with the commonest being concerns on discrimination, social stigma, inequitable access to healthcare, vaccine safety, efficacy, potency, side effects and lack of trust in medical workers. These impediments in vaccine coverage should be meticulously addressed to ensure optimum LGBTQIA+ physical and mental health as well as for providing non-discriminative, equitable and quality healthcare service regardless of the gender or sexual orientation of individuals.

Association between inflammatory cytokines/chemokines, clinical laboratory parameters, disease severity and in-hospital mortality in critical and mild COVID-19 patients without comorbidities or immune-mediated diseases

There are limited data on inflammatory cytokines and chemokines; the humoral immune response; and main clinical laboratory parameters as indicators for disease severity and mortality in patients with critical and mild COVID-19 without comorbidities or immune-mediated diseases in Saudi Arabia. We determined the expression levels of major proinflammatory cytokines and chemokines; C-reactive protein (CRP); procalcitonin; SARS-CoV-2 IgM antibody and twenty-two clinical laboratory parameters and assessed their usefulness as indicators of disease severity and in-hospital death. Our results showed a significant increase in the expression levels of SARS-CoV-2 IgM antibody; IL1-β; IL-6; IL-8; TNF-α and CRP in critical COVID-19 patients; neutrophil count; urea; creatinine and troponin were also increased. The elevation of these biomarkers was significantly associated and positively correlated with in-hospital death in critical COVID-19 patients. Our results suggest that the levels of IL1-β; IL-6; IL-8; TNF-α; and CRP; neutrophil count; urea; creatinine; and troponin could be used to predict disease severity in COVID-19 patients without comorbidities or immune-mediated diseases. These inflammatory mediators could be used as predictive early biomarkers of COVID-19 disease deterioration; shock and death among COVID-19 patients without comorbidities or immune-mediated diseases.

Echocardiographic Findings of Covid-19 Patients in Canton Sarajevo During the Third Wave of the Covid-19 Pandemic

Background

Increasing evidence indicates that COVID-19 may result in cardiac issues in certain individuals, such as myocarditis, arrhythmias, and heart failure. Ongoing research on echocardiographic manifestations is still limited.

Objective

To investigate the incidence and patterns of left and right ventricular dysfunction in COVID-19 patients.

Methods

This study retrospectively observed COVID-19 patients admitted to the Clinical Center of University of Sarajevo during the third wave, with a particular focus on cardiac evaluations.

Results

Our patients, predominantely male 155 (72.4%), with a mean age of 66.2±11.4, having hypertension 86 (40.1%), diabetes mellitus 61 (28.5%), hyperlipidemia 144 (67.3%), were active smokers 87 (40.6%), had family history of cardiovascular diseases 123 (57.5%) and were COVID-19 positive 95 (44.4%), presented because of chest pain 78 (36.4%), dyspnea 103 (48.1%), palpitations 67 (31.3%), fatigue 106 (49.5%) and peripheral oedema 30 (14.0%). COVID-19 patients reported much higher symptoms of dyspnea (65 (68.4%) vs 38 (31.9%)) and fatigue (73 (76.8%) vs 33 (27.7%)) than COVID-19 negative patients. On the initial laboratory report, COVID-19 patients had a significantly (p<0.05) higher mean score of C-reactive protein (24.0±4.8 vs. 6.0±2.1), D-dimer (1.6±2.5 vs 0.8±0.6), ALT (94.8±17.2 vs 36.5±19.9) and creatinine (128.0±80.8 vs. 93.4±40.1) when compared to COVID-19 negative patients. COVID-19 patients had enlarged left atrium diametes (31.6±5.6 vs 27.5±5.3), enlarged left ventricular diameter both in systole (27.9±18.1 vs 23.3±16.3) and diastole (39.3±24.1 vs 34.9±22.7), reduced left ventricular ejection fraction (53.5±9.2 vs 59.8±4.3) and elevated right ventricular systolic pressure (37.0±16.4 vs 35.1±8.6).

Conclusion

COVID-19 patients had enlarged left atrium, enlarged systolic and diastolic left ventricular diameter, reduced left ventricular ejection fraction and elevated right ventricular systolic pressure.

Gut microbiota in patients with COVID-19 and type 2 diabetes: A culture-based method

Background

The global pandemic of coronavirus disease 2019 (COVID-19) continues to affect people around the world, with one of the most frequent comorbidities being Type 2 Diabetes (T2D). Studies have suggested a link between disbalances in gut microbiota and these diseases, as well as with COVID-19, potentially due to inflammatory dysfunction. This study aims to analyze the changes in gut microbiota in COVID-19 patients with T2D using a culture-based method.

Methods

The stool samples were taken from 128 patients with confirmed COVID-19. Changes in the composition of gut microbiota were analyzed by culture-based method. The study used chi-squared and t-test to find significant differences in gut bacteria between samples and non-parametric correlation analysis to examine relationship between gut bacteria abundance, C-reactive protein (CRP) levels and length of stay (LoS) in COVID-19 patients without T2D.

Results

The gut microbiota of T2D patients with COVID-19 showed increased Clostridium spp., Candida spp., and decreased Bifidobacterium spp., Lactobacillus spp. Metformin-treated patients with T2D and COVID-19 without antibiotic treatment showed increased Bacteroides spp., Lactobacillus spp., and decreased Enterococcus, Clostridium compared to the same group with antibiotic treatment. The study also found a positive correlation between the abundance of certain gut microbiota genera, such as Klebsiella spp. and Enterococcus spp., and CRP levels and LoS in COVID-19 patients without and with T2D, while the abundance of other genera, such as Bifidobacterium spp. and Lactobacillus spp., was found to have a negative correlation.

Conclusion

In conclusion, this study provides important insights into the gut microbiota composition of SARS-CoV-2-infected individuals with T2D and its potential impact on the course of the disease. The findings suggest that certain gut microbiota genera may be associated with increased CRP levels and longer hospital stays. The significance of this study lies in the fact that it highlights the potential role of gut microbiota in the progression of COVID-19 in patients with T2D, and may inform future research and treatment strategies for this patient population. The future impact of this study could include the development of targeted interventions to modulate gut microbiota in order to improve outcomes for COVID-19 patients with T2D.

Vaccine research and development capacity in Central and West Asia: A path toward sustainable vaccine R&D programs

The ability to support a comprehensive vaccine research and development (R&D) portfolio from a health security perspective has taken on enhanced significance over the past 3 years whereby countries that had existing vaccine R&D infrastructure (G7, Russia and China) have been at the forefront of global efforts to combat COVID-19. Few countries outside of these key players have the infrastructure necessary to develop national vaccine programs, though this is beginning to change with investment across many low- and middle-income countries. These same opportunities exist for countries in Central and West Asia, and in this perspective, we highlight the existing infrastructure and expertise across seven countries (Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan) and propose opportunities for enhanced collaboration along with a bold proposal for establishing a new-build, regional vaccine translational research institute to facilitate the development of a robust, regional vaccine R&D environment to combat existing and future health challenges.

Celecoxib, Glipizide, Lapatinib, and Sitagliptin as potential suspects of aggravating SARS-CoV-2 (COVID-19) infection: a computational approach

COVID-19 caused by SARS-CoV-2 has emerged as a potential threat to human life, especially to people suffering from chronic diseases. In this study, we investigated the ability of selected FDA-approved drugs to inhibit TACE (tumor necrosis factor α converting enzyme), which is responsible for the shedding of membrane-bound ACE2 (angiotensin-converting enzyme2) receptors into soluble ACE2. The inhibition of TACE would lead to an increased population of membrane-bound ACE2, which would facilitate ACE2-Spike protein interaction and viral entry. A total of 50 drugs prescribed in treating various chronic diseases in Saudi Arabia were screened by performing molecular docking using AutoDock4.2. Based on docking energy (≤ -9.00 kcal mol^-1), four drugs (Celecoxib, Glipizide, Lapatinib, and Sitagliptin) were identified as potential inhibitors of TACE, with binding affinities up to 10⁶-10⁷ M^-1. Analysis of the molecular docking suggests that these drugs were bound to TACE's catalytic domain and interact with the key residues such as His405, Glu406, and His415, which are involved in active site Zn²⁺ ion chelation. Molecular dynamics simulation was performed to confirm the stability of TACE-drugs complexes. RMSD (root mean square deviation), RMSF (root mean square fluctuation), Rg (radius of gyration), and SASA (solvent accessible surface area) were within the acceptable limits. Free energy calculations using Prime-MM/GBSA suggest that Celecoxib formed the most stable complex with TACE, followed by Glipizide, Sitagliptin, and Lapatinib. The finding of this study suggests a mechanism for drugs to aggravate SARS-CoV-2 infection and hence high mortality in patients suffering from chronic diseases.Communicated by Ramaswamy H. Sarma.

COVID-19 patient characteristics and time to viral clearance: A retrospective observational study in a multiethnic population (United Arab Emirates)

BACKGROUND

SARS-CoV-2 virus is the causing agent of COVID-19. The factors contributing to delayed viral clearance are still unclear.

METHODS

We investigated the factors influencing the time to viral clearance in COVID-19 patients using medical records from 1785 adult patients of various ethnicities treated at NMC Royal Hospital in Abu Dhabi, UAE. The Cox-proportional Hazard Model was utilized to identify risk variables for delayed viral clearance, and the Kaplan-Meier plot was used to measure the time to viral clearance among different groups.

RESULTS

several factors have been associated with an increased risk of delayed viral clearance, including advanced age (p = 0.006), presence of cardiovascular diseases (p = 0.016), presentation with upper respiratory tract infection (URTI) (p = 0.043), and combined gastrointestinal (GIT) and symptoms (URTI) (p = 0.012). ICU admission and severity of COVID-19 also increased the risk for delayed viral clearance (p = 0.006, p < 0.001, respectively). 'The overall median viral clearance time was 24 days. It was 32 days among patients over 60, 21 among those with URTI, GIT symptoms, and asymptomatic, 24 among diabetics, and 46.5 days among cardiovascular patients. The median time till viral clearance was 30 days among severe COVID-19 patients and 39 days among ICU-admitted patients.

CONCLUSIONS

We concluded that advanced age, cardiovascular comorbidities, disease presentation, and severe COVID-19 outcomes increased the risk of delayed viral clearance. Identifying these factors allow decision makers to implement an early and comprehensive management strategy to improve the outcome.

Illness Risk Perceptions and Efficacy Beliefs Among Indonesian in the Course of COVID-19 Pandemic

COVID-19, a worldwide pandemic, has posed a significant challenge to public health systems worldwide. Health risk perception and efficacy belief are primary constructs influencing individuals' protective behavior due to the outbreak. Our study investigated each item of illness risk perception, efficacy belief, and its related factors concerning the COVID-19 pandemic. An analytical cross-sectional study was conducted among 227 respondents aged 17 to 70. Data collection was conducted using convenience sampling by distributing the web questionnaire between April and July 2020. Mann-Whitney or Kruskal-Wallis bivariate analysis was performed using SPSS version 21.0 to assess the relationship between individual characteristic factors, illness risk perception, and efficacy belief. The study established that respondents had a medium to a high level of illness risk perception and a reasonable efficacy belief in dealing with the COVID-19 pandemic. Region (p=0.027) and occupation (p=0.036) differences were significantly associated with the threat and severity perception, respectively. Smoking history (p=0.037), supplement use (p=0.029), and occupation (p=0.018) differences were significantly associated with self-efficacy. Meanwhile, gender (p=0.045) differences were significantly associated with response efficacy. Therefore, the public's illness risk perception and efficacy belief could be substantial in planning, modifying, and implementing a coordinated response for risk communication in current and future epidemics.

Histopathologic Changes of Appendicitis Stage During the COVID-19 Pandemic

Background: We decided to compare the pathology stage of appendicitis in patients referred to Firoozabadi Medical Center before and after the official announcement of the coronavirus outbreak in Iran because we believe that people's fears of COVID-19 are keeping them away from hospitals and it likely causes them to come in later stages of the disease. Therefore, this study aims at investigating the effect of the COVID-19 pandemic on the stage of appendicitis at presentation. Methods: In this retrospective study, histopathology records of all acute appendicitis patients who underwent an emergency appendectomy in the surgical unit in our institute between December 2019 and April 2020 were reviewed retrospectively. The study period was designed to include 2 months before and 2 months after the officially announced onset of the COVID-19 outbreak in Iran on February 20, 2020. All cases of complicated appendicitis (perforated appendicitis, phlegmonous appendix, itis or abscess) were excluded. Descriptive statistics were used to describe our study variables. Furthermore, ordinal logistic regression was used to investigate the effect of the COVID-19 pandemic and demographic variables on the stage of appendicitis at presentation. Data were analyzed using SPSS Statistics Version 22. Results: The study was conducted on 170 clinically diagnosed acute appendicitis patients. The odds ratio for gender was equal to 0.45 (0.23, 0.86), which means that women presented at an earlier pathological stage than men ( p = 0.016). Also, patients who had health insurance were 50% less likely to present in later pathological stages than those who did not ( p = 0.024). The COVID-19 outback did not have a significant role in the pathological stage at presentation ( p = 0.235). Conclusion: The number of appendicitis patients was down by about 50% following the outbreak announcement in Iran. Surprisingly, we did not find any significant changes in the distribution pattern of appendicitis pathological staging after the outbreak. Being uninsured and male sex were found to have the most significant roles in delayed hospital presentation and higher pathological stages in patients with acute appendicitis.

Knowledge, Attitudes, and Perception towards COVID-19 among Medical Students in Yemen: A Cross-Sectional Survey

Numerous measures have been taken to slow the Coronavirus disease (COVID-19) rapid spread. Such population control techniques may have a substantial impact on people’s attitudes, knowledge, and perception of COVID-19. This web-based cross-sectional survey aimed to assess Knowledge, Attitude, and Practices (KAP) towards COVID-19 among Hadhramout University Medical Students in Yemen from 15 June to 26 June 2020. This survey was performed using social media via the Google Platform among 422 Hadhramout University Medical students. After consenting, participants completed an online survey assessing sociodemographic data, 21 knowledge items, 15 attitudes items, and 5 perception items towards COVID-19. Of the total 422 participants, 389 (92.18%) were surveyed online, and 256 (65.8%) were females, and 133 (34.2%) were males aged 19-24 years (88.7%), studying medicine (58.9%), and living in urban areas (80.7%). The survey revealed that 64.0% of participants had good knowledge about the disease and 52.7% had positive attitudes towards protective measures against the virus. The majority of participants (98.2%) thought that the virus was transmitted through nasal droplets, and 59.6% agreed that the disease is dangerous. The majority of participants agreed that fever (99.2%), dry cough (97.9%), and difficulty breathing (99.5%) are the most common symptoms of the disease. The survey also showed high knowledge levels about preventive measures against the virus spreading, such as regular proper hand hygiene (99.7%), maintaining an appropriate distance (99.2%), avoiding touching eyes and nose (98.7%), and wearing facemasks in public places (97.4%). Moreover, 69.7% of participants agreed to be isolated at home if they got an infected person, 64.3% implemented washing hands with soap and water, 41.9% agreed to be separated at the hospital until they proved free from the disease, 46.0% agreed to inform the health authorities if they had any symptoms associated with the disease. By using sample T-test and analysis of variance (ANOVA), mean knowledge score about COVID-19 was significantly higher in males than in females (p = 0.029). Additionally, medicine students had significantly higher mean knowledge score than students of medical laboratory (p < 0.001) and nursing (p = 0.008). In general, our research revealed that participants had favorable opinions regarding the disease’s preventative measures and a good awareness of it. However, more educational initiatives and campaigns that take into account KAP modifying elements are needed.

Quality of Life of Elementary School Students with Type 1 Diabetes in a Developing Country during the COVID Pandemic

Type 1 diabetes (T1D) is a condition that affects all aspects of life, and thus is closely related to the quality of life itself. Dealing with it during the COVID-19 pandemic is a big challenge. A case-control study conducted in Montenegro at the end of 2021 included 87 elementary school students with T1D and 248 of their peers as controls matched by gender. Standardized questionnaires were distributed to participants (Peds-QL Generic core 4.0 questionnaire for all participants and Peds-QL Diabetes Module 3.2 only for cases). Based on them, the results of obtained scores were measured and compared using non-parametric statistical methods in relation to gender, region and type of household. Children with T1D reported lower quality of life comparing to matching controls with lower scores in almost all domains. Differences in the same domains among patients and their classmates were also observed in the different gender subgroups, environment type subgroups and in the central region. Results of the study provide insights to prioritizing actions for children with diabetes care as well as for public healthcare planning.

Reorganization of Intensive Care Units for the COVID-19 pandemic: effects on nursing sensitive outcomes

BACKGROUND

Since the first months of 2020 COVID-19 patients who were seriously ill due to the development of ARDS, required admission to the intensive care unit to ensure potentially life-saving mechanical ventilation and support for vital functions. To cope with this emergency, an extremely rapid reorganization of premises, services and staff, to dedicate an entire intensive care unit exclusively to SARS-CoV-2 patients and increasing the number of beds was essential. The aim of the study was to evaluate the effects of reorganization of the COVID-19 intensive care unit in terms of nursing sensitive outcomes.

METHODS

a retrospective observational study was conducted to compare nursing sensitive outcomes between pre-COVID period and COVID period.

RESULTS

Falls (0.0 and 0.4%, respectively), physical restraint (1.8 and 1.1%, respectively), and pressure ulcers (8.0 and 3.0%, respectively) were similar in the COVID and in the pre-COVID group. After adjusting for gender, age, BMI, and number of comorbidities, the incidence of bloodstream infections was significantly higher in the COVID group than in the pre-COVID group. There were no statistically significant differences in the incidence between the two groups regarding other evaluated outcomes.

CONCLUSION

The selected nursing sensitive outcomes maintained similar values in the pre-COVID and COVID patient groups. Healthcare-related infections rate must be considered an important alarm signal of quality of nursing care especially in conditions of excessive workload, stress and the presence of less experienced staff increase.

Providing Solution in an Emergency: COVID-19 and Voice Behavior of Healthcare Professionals

This study investigates the mechanism between idiosyncratic deals (I-deals) and voice behavior, considering display aggression and deontic justice as mediating variables. We collected data from 702 nurses and their immediate supervisors who work with COVID-19 patients through survey questionnaires at two different times, and we analyzed the data using structural equation modeling (SEM). We found that I-deals are significantly associated with deontic justice and voice behavior. Moreover, I-deals are significant but negatively associated with displayed aggression, which is significant and negatively associated with voice behavior. In addition, deontic justice and display aggression mediate the association between I-deals and voice behavior. These findings suggest that the hospitals' top management should provide I-deals to nurses to improve their voice behavior.

Leveraging artificial intelligence and data science techniques in harmonizing, sharing, accessing and analyzing SARS-COV-2/COVID-19 data in Rwanda (LAISDAR Project): study design and rationale

Background

Since the outbreak of COVID-19 pandemic in Rwanda, a vast amount of SARS-COV-2/COVID-19-related data have been collected including COVID-19 testing and hospital routine care data. Unfortunately, those data are fragmented in silos with different data structures or formats and cannot be used to improve understanding of the disease, monitor its progress, and generate evidence to guide prevention measures. The objective of this project is to leverage the artificial intelligence (AI) and data science techniques in harmonizing datasets to support Rwandan government needs in monitoring and predicting the COVID-19 burden, including the hospital admissions and overall infection rates.

Methods

The project will gather the existing data including hospital electronic health records (EHRs), the COVID-19 testing data and will link with longitudinal data from community surveys. The open-source tools from Observational Health Data Sciences and Informatics (OHDSI) will be used to harmonize hospital EHRs through the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM). The project will also leverage other OHDSI tools for data analytics and network integration, as well as R Studio and Python. The network will include up to 15 health facilities in Rwanda, whose EHR data will be harmonized to OMOP CDM.

Expected results

This study will yield a technical infrastructure where the 15 participating hospitals and health centres will have EHR data in OMOP CDM format on a local Mac Mini (“data node”), together with a set of OHDSI open-source tools. A central server, or portal, will contain a data catalogue of participating sites, as well as the OHDSI tools that are used to define and manage distributed studies. The central server will also integrate the information from the national Covid-19 registry, as well as the results of the community surveys. The ultimate project outcome is the dynamic prediction modelling for COVID-19 pandemic in Rwanda.

Discussion

The project is the first on the African continent leveraging AI and implementation of an OMOP CDM based federated data network for data harmonization. Such infrastructure is scalable for other pandemics monitoring, outcomes predictions, and tailored response planning.

WASH to control COVID-19: A rapid review

Background

Preventive public health has been suggested as methods for reducing the transmission of COVID-19. Safety and efficacy of one such public health measure: WASH intervention for COVID-19 has not been systematically reviewed. We undertook a rapid review to assess the effect of WASH intervention in reducing the incidence of COVID-19.

Methods

We conducted searches in PubMed, MEDLINE, and EMBASE. We undertook screening of studies in two stages and extracted data and assessed the quality of evidence for the primary outcome using GRADE recommendations.

Main results

We included a total of 13 studies with three studies on COVID-19 and 10 on SARS. The study found that hand washing, sterilization of hands, gargling, cleaning/shower after attending patients of COVID-19, or SARS was protective. Evidence also found that frequent washes can prevent SARS transmission among HCWs. However; one study reported that due to enhanced infection-prevention measures, front-line HCWs are more prone to hand-skin damage. The certainty of the evidence for our primary outcome as per GRADE was very low. We did not find any studies that assessed the effect of WASH on hospitalizations, and mortality due to COVID-19. Also; we did not find any study that compared WASH interventions with any other public health measures.

Conclusions

Current evidence of WASH interventions for COVID-19 is limited as it is largely based on indirect evidence from SARS. Findings from the included studies consistently show that WASH is important in reducing the number of cases during a pandemic. Timely implementation of WASH along with other public health interventions can be vital to ensure the desired success. Further good-quality studies providing direct evidence of the efficacy of WASH on COVID-19 are needed.

Perception Towards COVID-19 Related Symptoms and Traditional Medicine Used for Their Management Among Patients and Their Attendants in Ethiopian Comprehensive Specialized Hospitals: A Cross-Sectional Study

Background

Methods

Results

Conclusion

Corticosteroids showed more efficacy in treating hospitalized patients with COVID-19 than standard care but the effect is minimal: A systematic review and meta-analysis

Background

During the ongoing coronavirus disease 2019 (COVID-19) pandemic, the use of corticosteroids for COVID-19 has ignited worldwide debate. Previous systematic reviews, including randomized controlled trials (RCTs) and retrospective observational studies, found that corticosteroids have beneficial effects in treating COVID-19.

Aim

This systematic review and meta-analysis only included RCTs to assess the effectiveness and safety of corticosteroids in hospitalized patients with COVID-19.

Methods

Comprehensive research strategies (PubMed, Embase, MEDLINE, and Coherence Library) were used to search for RCTs from December 2019 to January 2021.

Results

Five RCTs were included with 7,235 patients, of which 2,508 patients were receiving corticosteroid treatments (dexamethasone or methylprednisolone), and 4,727 received standard care. The primary outcome was mortality within 28 days. The use of corticosteroids decreased the 28-day mortality of patients with COVID-19, but the findings were not statistically significant (RR, 0.91; 95% CI, 0.78–1.06, p = 0.24). The secondary outcome was the duration of hospitalization; no differences were found between the corticosteroid and standard care groups. However, corticosteroids were associated with a higher hospital discharge rate than standard treatment, but the result was not statistically significant (RR, 1.36; 95% CI, 0.95–1.96, p = 0.09).

Conclusions

The results suggest that corticosteroids are comparable to standard care in terms of safety in treating COVID-19. Corticosteroids showed greater efficacy than standard care; however, the effect was minimal.

Serum hemato-immunological biomarkers associated with increased COVID-19 mortality in the Latino population

Introduction: COVID-19 hospitalizations and deaths have raised the need of identifying prognostic factors for medical decision-making. Methods: Observational, retrospective study analyzing 191 COVID-19 patients' serum inflammatory biomarkers. Results: The median age was 48.7 ± 12.7 years, 75.9% being men. Overweight/obesity was the most common comorbidity in 83.8% of patients. 44.5% had moderate disease followed by 43.5% with severe disease. The mean percentage of pulmonary damage was 53.4% ± 28.7. Serum leukocyte-to-lymphocyte ratio >7.7, neutrophil-to-lymphocyte ratio >10, platelet-to-lymphocyte ratio ≥250 and nutritional index <362 all were independent mortality predictors for COVID-19. Conclusions: A leukocyte-to-lymphocyte ratio >7.7 as well as a nutritional index <362 at hospitalization were independently associated with an increased mortality.

Specific serological inflammatory biomarkers including leukocyte-to-lymphocyte ratio >7.7 and nutritional index <362 are important mortality predictor factors that must be used in the management of COVID-19 hospitalized patients.

Sponge Whirl-Pak Sampling Method and Droplet Digital RT-PCR Assay for Monitoring of SARS-CoV-2 on Surfaces in Public and Working Environments

The SARS-CoV-2 can spread directly via saliva, respiratory aerosols and droplets, and indirectly by contact through contaminated objects and/or surfaces and by air. In the context of COVID-19 fomites can be an important vehicle of virus transmission and contribute to infection risk in public environments. The aim of the study was to analyze through surface sampling (sponge method) the presence of SARS-CoV-2 in public and working environments, in order to evaluate the risk for virus transmission. Seventy-seven environmental samples were taken using sterile sponges in 17 animal farms, 4 public transport buses, 1 supermarket and 1 hotel receptive structure. Furthermore, 246 and 93 swab samples were taken in the farms from animals and from workers, respectively. SARS-CoV-2 detection was conducted by real-time RT-PCR and by digital droplet RT-PCR (dd RT-PCR) using RdRp, gene E and gene N as targets. None of the human and animal swab samples were positive for SARS-CoV-2, while detection was achieved in 20 of the 77 sponge samples (26%) using dd RT-PCR. Traces of the RdRp gene, gene E and gene N were found in 17/77 samples (22%, average concentration 31.2 g.c./cm², range 5.6 to 132 g.c./cm²), 8/77 samples (10%, average concentration 15.1 g.c./cm², range 6 to 36 g.c./cm²), and in 1/77 (1%, concentration 7.2 g.c./cm²). Higher detection rates were associated with sampling in animal farms and on public transport buses (32% and 30%) compared to the supermarket (21%) and the hotel (no detection). The result of the study suggests that the risk of contamination of surfaces with SARS-CoV-2 increases in environments in which sanitation strategies are not suitable and/or in highly frequented locations, such as public transportation. Considering the analytical methods, the dd RT-PCR was the only approach achieving detection of SARS-CoV-2 traces in environmental samples. Thus, dd RT-PCR emerges as a reliable tool for sensitive SARS-CoV-2 detection.

Activity of a Carbohydrate-Binding Module Therapy, Neumifil, against SARS-CoV-2 Disease in a Hamster Model of Infection

The rapid global spread of severe acute respiratory coronavirus 2 (SARS-CoV-2) has resulted in an urgent effort to find efficacious therapeutics. Broad-spectrum therapies which could be used for other respiratory pathogens confer advantages, as do those based on targeting host cells that are not prone to the development of resistance by the pathogen. We tested an intranasally delivered carbohydrate-binding module (CBM) therapy, termed Neumifil, which is based on a CBM that has previously been shown to offer protection against the influenza virus through the binding of sialic acid receptors. Using the recognised hamster model of SARS-CoV-2 infection, we demonstrate that Neumifil significantly reduces clinical disease severity and pathological changes in the nasal cavity. Furthermore, we demonstrate Neumifil binding to the human angiotensin-converting enzyme 2 (ACE2) receptor and spike protein of SARS-CoV-2. This is the first report describing the testing of this type of broad-spectrum antiviral therapy in vivo and provides evidence for the advancement of Neumifil in further preclinical and clinical studies.