Wuhan to World: The COVID-19 Pandemic

Detection method of viral pneumonia imaging features based on CT scan images in COVID-19 case study

This study aims to automatically analyze and extract abnormalities in the lung field due to Coronavirus Disease 2019 (COVID-19). Types of abnormalities that can be detected are Ground Glass Opacity (GGO) and consolidation. The proposed method can also identify the location of the abnormality in the lung field, that is, the central and peripheral lung area. The location and type of these abnormalities affect the severity and confidence level of a patient suffering from COVID-19. The detection results using the proposed method are compared with the results of manual detection by radiologists. From the experimental results, the proposed system can provide an average error of 0.059 for the severity score and 0.069 for the confidence level. This method has been implemented in a web-based application for general users.•A method to detect the appearance of viral pneumonia imaging features, namely Ground Glass Opacity (GGO) and consolidation on the chest Computed Tomography (CT) scan images.•This method can separate the lung field to the right lung and the left lung, and it also can identify the detected imaging feature's location in the central or peripheral of the lung field.•Severity level and confidence level of the patient's suffering are measured.

Inhibitory effects of senkyuchachosan on SARS-CoV-2 papain-like protease activity in vitro

Papain-like protease (PLpro) enzyme plays a vital role in viral replication as it breaks down polyproteins and disrupts the host's immune response. There are few reports on Kampo formulas that focus on PLpro activity. In this study, we evaluated the inhibitory effects of senkyuchachosan, a traditional Japanese medicine, on PLpro of SARS-CoV-2, the virus responsible for causing COVID-19. We purified the PLpro enzyme and conducted in vitro enzymatic assays using specific substrates. Among the nine crude drugs present in senkyuchachosan, four (Cyperi Rhizoma, Schizonepetae Spica, Menthae Herba, and Camelliae sinensis Folium [CsF]) strongly inhibited PLpro activity. CsF, derived from Camellia sinensis (green tea), contains polyphenols, including catechins and tannins. To confirm that the PLpro inhibitory effects of senkyuchachosan predominantly stem from tannins, the tannins were removed from the decoction using polyvinylpolypyrrolidone (PVPP). The inhibitory effect of senkyuchachosan on PLpro activity was reduced by the removal of PVPP. In addition, the tannin fraction obtained from the CsF extracts showed significant PLpro inhibitory effects. These findings lay the groundwork for the potential development of therapeutic agents that target SARS-CoV-2 infection by intervening in proteolytic cleavage of the virus.

Unraveling the Role of the Blood-Brain Barrier in the Pathophysiology of Depression: Recent Advances and Future Perspectives

Depression is a highly prevalent psychological disorder characterized by persistent dysphoria, psychomotor retardation, insomnia, anhedonia, suicidal ideation, and a remarkable decrease in overall well-being. Despite the prevalence of accessible antidepressant therapies, many individuals do not achieve substantial improvement. Understanding the multifactorial pathophysiology and the heterogeneous nature of the disorder could lead the way toward better outcomes. Recent findings have elucidated the substantial impact of compromised blood-brain barrier (BBB) integrity on the manifestation of depression. BBB functions as an indispensable defense mechanism, tightly overseeing the transport of molecules from the periphery to preserve the integrity of the brain parenchyma. The dysfunction of the BBB has been implicated in a multitude of neurological disorders, and its disruption and consequent brain alterations could potentially serve as important factors in the pathogenesis and progression of depression. In this review, we extensively examine the pathophysiological relevance of the BBB and delve into the specific modifications of its components that underlie the complexities of depression. A particular focus has been placed on examining the effects of peripheral inflammation on the BBB in depression and elucidating the intricate interactions between the gut, BBB, and brain. Furthermore, this review encompasses significant updates on the assessment of BBB integrity and permeability, providing a comprehensive overview of the topic. Finally, we outline the therapeutic relevance and strategies based on BBB in depression, including COVID-19-associated BBB disruption and neuropsychiatric implications. Understanding the comprehensive pathogenic cascade of depression is crucial for shaping the trajectory of future research endeavors.

COVID-19 with high-sensitivity CRP associated with worse dynamic clinical parameters and outcomes

Objective

This study aimed to evaluate the relationship between high-sensitivity C-reactive protein (hsCRP) in hospitalized COVID-19 patients and their clinical outcomes, including trajectory of hsCRP changes during hospitalization.

Method and results

Patients with positive COVID-19 tests between 2021 and 2023 were admitted to two hospitals. Among 184 adult patients, approximately half (47.3%) had elevated hsCRP levels upon admission, which defined as exceeding the laboratory-specific upper limit of test (> 5.0 mg/L). Clinical outcomes included critical illness, acute kidney injury, thrombotic events, intensive care unit (ICU) requirement, and death during hospitalization. Elevated hsCRP levels had a higher risk of ICU requirement than those with normal, 39.1% versus 16.5%; adjusted odds ratio (aOR), 2.3 [95% CI, 1.05-5.01]; p = 0.036. Patients with extremely high (≥2 times) hsCRP levels had aOR, 2.65 [95% CI, 1.09-6.45]; p < 0.001. On the fifth day hospitalization, patients with high hsCRP levels associated with acute kidney injury (aOR, 4.13 [95% CI, 1.30-13.08]; p = 0.016), ICU requirement (aOR, 2.67 [95%CI, 1.02-6.99]; p = 0.044), or death (aOR, 4.24 [95% CI, 1.38-12.99]; p = 0.011). The likelihood of worse clinical outcomes increased as hsCRP levels rose; patients with elevated hsCRP had lower overall survival rate than those with normal (p = 0.02). The subset of high hsCRP patients with high viral load also had a shorter half-life compared to those with normal hsCRP level (p = 0.003).

Conclusion

Elevated hsCRP levels were found to be a significant predictor of ICU requirement, acute kidney injury, or death within 5 days after hospitalization in COVID-19 patients. This emphasized the importance of providing more intensive care management to patients with elevated hsCRP.

Post-COVID-19 conditions in children and adolescents diagnosed with COVID-19

BACKGROUND

This study aimed to investigate the prevalence of and the factors associated with post-COVID-2019 condition in COVID-19 children and adolescents in Germany.

METHODS

The present retrospective cohort study used data from the Disease Analyzer database (IQVIA), and included patients aged <18 years who were diagnosed with COVID-19 in one of 524 general and 81 pediatric practices in Germany between October 2020 and August 2021 (index date: first COVID-19 diagnosis). Post-COVID-19 condition was assessed between the index date and November 2021. Covariates included age, sex, type of practice, and chronic conditions documented in at least 1% of the population.

RESULTS

There were 6568 children and adolescents included in this study (mean [SD] age 10.1 [4.9] years; 49.2% girls). The prevalence of post-COVID-19 condition was 1.7% in the population. Patients aged 13-17 years were more likely to be diagnosed with post-COVID-19 condition compared with those being aged ≤5 years (RR = 3.14). Anxiety disorders (RR = 2.53), somatoform disorders (RR = 2.11), and allergic rhinitis (RR = 2.02) were also significantly associated with post-COVID-19 condition.

CONCLUSION

Post-COVID-19 condition was rare in COVID-19 children and adolescents in Germany. Data from other settings are warranted to confirm these findings.

IMPACT

The prevalence of post-COVID-19 condition was 1.7% in this population of children and adolescents. Older children and adolescents were more likely to be diagnosed with post-COVID-19 condition than their younger counterparts. Anxiety disorders, somatoform disorders, and allergic rhinitis were significantly associated with post-COVID-19 condition. More data from other settings and countries are warranted to corroborate or refute these findings.

An Exploratory Study of the Impact of COVID-19 Vaccine Spontaneous Reporting on Masking Signal Detection in EudraVigilance

INTRODUCTION

During the signal detection process, statistical methods are used to identify drug-event combinations (DECs) which are disproportionately reported when compared with other drugs and events in the entire database. We hypothesise that the high volume of COVID-19 vaccine adverse drug reaction (ADR) reports transmitted to EudraVigilance may have affected the performance of disproportionality statistics used in routine signal detection, potentially resulting in signals either being masked, or false associations being flagged as potential signals.

OBJECTIVE

Our aim was to study the impact of COVID-19 vaccine spontaneous reporting on statistical signal detection in EudraVigilance.

METHODS

We recalculated the reporting odds ratio (ROR) for signals that were previously discussed at the level of the Pharmacovigilance Risk Assessment Committee, or signals that were retrieved from EudraVigilance, by omitting COVID-19 vaccine reports from the standard ROR calculation and then comparing the lower confidence interval (LCI) of the recalculated ROR to the LCI of the actual ROR in EudraVigilance.

RESULTS

In total, 52 signals for 38 active substances were reviewed. For 35 signals, the LCI of the recalculated ROR value was lower than the LCI of the actual ROR (suggesting that COVID-19 vaccine ADR reporting had a positive effect on the strength of the signal) while for 15 signals the LCI of the recalculated ROR value was higher than the LCI of the actual ROR (suggesting that COVID-19 vaccine ADR reporting had an attenuating effect on the strength of the signal). For two signals, no change in the ROR was observed. In our analysis, six significant results were found. Five DECs were found to be masked: bleomycin and immune thrombocytopenia (actual ROR LCI = 0.94, recalculated ROR LCI = 1.02), vortioxetine and heavy menstrual bleeding (actual ROR LCI = 0.3, recalculated ROR LCI = 1.06), caplacizumab and heavy menstrual bleeding (actual ROR LCI = 0.98, recalculated ROR LCI = 3.47), ziprasidone and amenorrhoea (actual ROR LCI = 0.84, recalculated ROR LCI = 1.67), and azacitidine and pericarditis (actual ROR LCI = 0.81, recalculated ROR LCI = 2.01). For the DEC of adalimumab and immune reconstitution inflammatory syndrome, the LCI of the actual ROR value was 1.14 and removing COVID-19 vaccine reporting resulted in an LCI of the recalculated ROR value of 0.94 (below threshold).

CONCLUSIONS

We demonstrated five cases of masking and one case of false-positive association due to the influence of COVID-19 vaccine spontaneous reporting on the ROR. This suggests that the high number of adverse drug reaction reports for COVID-19 vaccines in EudraVigilance has the potential to affect routine statistical signal detection activities. The impact of COVID-19 vaccine ADR reports on current signal detection practices requires further evaluation and solutions to tackle masking issues in EudraVigilance may need to be developed.

The Effect of COVID-19 Restrictions on General and HIV Positive Inpatient Admissions and Treatment Outcomes: An Uncontrolled Before-and-after Study at a Ugandan Tertiary Hospital

Measures to contain the Corona Virus Disease 2019 (COVID-19) pandemic curtailed access to prevention and treatment services for endemic infectious diseases like HIV. We used an uncontrolled before-and-after study design to compare general and HIV positive (HIV+) inpatient outcomes at a tertiary hospital in Uganda, using electronic records of medical inpatients. Data was downloaded, cleaned in Microsoft Excel, and exported to STATA for analysis. We determined the difference in number of admissions and median length of hospital stay using Mann-Whitney U test; and difference in median survival and incidence rates of mortality using Kaplan - Meier statistics, between the pre- and peri-COVID-19 groups. Of 7506 patients admitted to Kiruddu NRH, 50.8% (3812) were female and 18.7% (1,401) were aged 31-40 years, and 18.8% (1,411) were HIV+. Overall, 24.6% (1849) died. Total admissions were lower (2192 vs. 5314 patients), overall mortality rate higher (41.8% vs. 17.6%, p < 0.01), median length of hospital stay longer (6 vs. 4 days, p < 0.01) and median survival shorter (11 vs. 20 days, Chi-square = 252.05, p < 0.01) in the peri- than in pre-COVID-19 period. The adjusted hazard ratio (aHR) of death was 2.08 (95% CI: 1.85-2.23, p < 0.01) in the peri- compared to the pre-COVID-19 period. These differences were more pronounced in HIV + patients. Compared to pre-COVID-19, the peri-COVID-19 period registered lower inpatient admissions but poorer treatment outcomes for general and HIV + inpatients. Emerging epidemic responses should minimize disruption to inpatient care, especially for HIV + individuals.

Immunogenicity and Tolerability of a SARS-CoV-2 TNX-1800, a Live Recombinant Poxvirus Vaccine Candidate, in Syrian Hamsters and New Zealand White Rabbits

TNX-1800 is a preclinical stage synthetic-derived live attenuated chimeric horsepox virus vaccine engineered to express the SARS-CoV-2 spike (S) gene. The objectives of this study were to assess the safety, tolerability, and immunogenicity of TNX-1800 administration in Syrian golden hamsters and New Zealand white rabbits. Animals were vaccinated at three doses via percutaneous inoculation. The data showed that the single percutaneous administration of three TNX-1800 vaccine dose levels was well tolerated in both hamsters and rabbits. At all dose levels, rabbits were more decerning regarding vaccine site reaction than hamsters. Lastly, no TNX-1800 genomes could be detected at the site of vaccination. Post-vaccination, all animals had anti-SARS-CoV-2 spike protein IgG specific antibody responses. These data demonstrate that TNX-1800 infection was limited, asymptomatic, and cleared by the end of this study, and a single dose was able to generate immune responses.

Polymerase chain reaction-positivity and predictors for SARS-CoV-2 infection among diagnosed cases' in North West Ethiopia

Background

The lack of sophisticated diagnosing equipment for polymerase chain reaction (PCR) during the incidence of variant types of COVID-19 underestimates the morbidity and mortality patterns of this pandemic. Thus, this study aimed to estimate seropositive and confirmatory predictors for COVID-19 suspected and tested cases through polymerase chain reaction (RT-PCR) in two diagnosing.

Methods

A facility-based descriptive cross-sectional study was employed among COVID-19 suspected cases from January 2, 2022, to June 9, 2022. The data were collected both using a structured interviewees and nasopharyngeal (NP) swabs. The nasal swab (NS) was analyzed in the laboratory for RNA detection of the virus using PCR. The collected data were entered into Epi Data version 4.2 and then exported to STATA (SE) version R-14 software for further analysis. multivariable logistic regression was used to assess the associated risk.

Results

A total of 285 suspected cases have participated in this study. The overall mean (±SD) age of the participants was 37.5 (±18.5) years. The majority, 174 (61.1%) of the tested groups were symptomatic when diagnosed. The positivity of RT-PCR for suspected and COVID-19 diagnosed cases were confirmed in 62/285 (21.75%). In multivariable analysis, they were aged 26-50 years (adjusted odds ratio [AOR] = 4.2, 95% confidence interval [CI] = 1.5-10.75), had comorbidity (AOR = 5.8; 95% CI = 2.1-12.2), and cigarette smokers (AOR = 13.5; 95% CI = 5.3-36.6) were significantly associated with developing COVID-19 infection.

Conclusion

More than two in every nine suspected cases were positive RT-PCR tests, and the infectivity of COVID-19 was significantly associated with age 25-50 years, comorbidities, and cigarette smoking. The deployment of high-quality diagnostic kits like RT-PCR is crucial for the early detection and risk stratification of suspected cases.

SARS-CoV-2 induced changes in the glycosylation pattern in the respiratory tract of Golden Syrian hamsters

Even after more than two years of intensive research, not all of the pathophysiological processes of Coronavirus Disease 2019 (COVID-19), induced by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection, have been fully elucidated. The initial virus-host interaction at the respiratory epithelium plays a crucial role in the course and progression of the infection, and is highly dependent on the glycosylation pattern of the host cell and of the secreted mucins. Glycans are polysaccharides that can be attached to proteins and thereby add to their stability and functionality. Lectins are glycan-binding proteins that recognize specific glycan motifs, and lectin histochemistry is a suitable tool to visualize and examine glycosylation pattern changes in tissues. In this study we used lectins with different glycan-specificities for the visualization of glycosylation pattern changes in the respiratory tract of SARS-CoV-2 infected Golden Syrian hamsters. While some lectins (LEL, STL) enable the visualization of the damage to alveolar type 1 pneumocytes, other lectins, e.g., GSLI, visualized the loss and subsequent hyperplasia of type 2 pneumocytes. UEAI staining was co-localized with KI67, a proliferation marker. Double staining of lectins LEL, STL and WGA with specific immune cell markers (Iba1, CD68) showed co-localization and the dominant infiltration of monocyte-derived macrophages into infected alveolar tissue. The elucidation of the glycosylation pattern of the respiratory tract cells in uninfected and infected Golden Syrian hamsters revealed physiological and pathological aspects of the disease that may open new possibilities for therapeutic development.

Cardiovascular Disease and COVID-19 Vaccines: A Systematic Review and Analysis of Published Cases

As vaccination against COVID-19 became more widespread, side-effects that were not initially detected during clinical trials became more prominent. The aim of this systematic review is to discuss reports of adverse cardiovascular events associated with COVID-19 vaccination. Databases were searched from inception up to August 2022 to identify case reports and case series reporting on patients with cardiovascular disease after COVID-19 vaccination. This study assessed 150 published cases. Of these, 109 were case reports and 41 were case series. The majority of patients were male (n=302, 86.6%), with a mean age of 27.6 ± 16.7 years. Of the included patients, 268 (76.6%) had myocarditis, 50 (14.6%) had myopericarditis, 8 (2.3%) had pericarditis, and only 4 (1.1%) had stress-induced cardiomyopathy. Moreover, 30 (8.6%) and 11 (3.1%) were diagnosed with arrhythmia and ischaemic heart disease, respectively. Ultimately, cardiovascular complications after COVID-19 vaccination include myocarditis, myopericarditis, ischaemic heart disease and arrhythmia. The young population, especially young male patients, could be more vulnerable to myocarditis.

Training and testing of a gradient boosted machine learning model to predict adverse outcome in patients presenting to emergency departments with suspected covid-19 infection in a middle-income setting

COVID-19 infection rates remain high in South Africa. Clinical prediction models may be helpful for rapid triage, and supporting clinical decision making, for patients with suspected COVID-19 infection. The Western Cape, South Africa, has integrated electronic health care data facilitating large-scale linked routine datasets. The aim of this study was to develop a machine learning model to predict adverse outcome in patients presenting with suspected COVID-19 suitable for use in a middle-income setting. A retrospective cohort study was conducted using linked, routine data, from patients presenting with suspected COVID-19 infection to public-sector emergency departments (EDs) in the Western Cape, South Africa between 27th August 2020 and 31st October 2021. The primary outcome was death or critical care admission at 30 days. An XGBoost machine learning model was trained and internally tested using split-sample validation. External validation was performed in 3 test cohorts: Western Cape patients presenting during the Omicron COVID-19 wave, a UK cohort during the ancestral COVID-19 wave, and a Sudanese cohort during ancestral and Eta waves. A total of 282,051 cases were included in a complete case training dataset. The prevalence of 30-day adverse outcome was 4.0%. The most important features for predicting adverse outcome were the requirement for supplemental oxygen, peripheral oxygen saturations, level of consciousness and age. Internal validation using split-sample test data revealed excellent discrimination (C-statistic 0.91, 95% CI 0.90 to 0.91) and calibration (CITL of 1.05). The model achieved C-statistics of 0.84 (95% CI 0.84 to 0.85), 0.72 (95% CI 0.71 to 0.73), and 0.62, (95% CI 0.59 to 0.65) in the Omicron, UK, and Sudanese test cohorts. Results were materially unchanged in sensitivity analyses examining missing data. An XGBoost machine learning model achieved good discrimination and calibration in prediction of adverse outcome in patients presenting with suspected COVID19 to Western Cape EDs. Performance was reduced in temporal and geographical external validation.

Metabolic Associated Fatty Liver Disease (MAFLD) and COVID-19 Infection: An Independent Predictor of Poor Disease Outcome?

Background and Objectives: Early reports on COVID-19 infection suggested that the SARS-CoV-2 virus solely attacks respiratory tract cells. As the pandemic spread, it became clear that the infection is multiorganic. Metabolic associated fatty liver disease (MAFLD) is a chronic liver disease strongly associated with insulin resistance and diabetes. The aim of this study was to assess a possible interplay between MAFLD and COVID-19 infection and its implication in COVID-19 outcome. Materials and Methods: A retrospective observational study, including 130 COVID-19 positive patients was conducted. MAFLD diagnosis was made based on the International Consensus criteria. Patients were divided into two groups, group A (MAFLD) and group B (nonMAFLD). Anthropometric and laboratory analysis were obtained. COVID-19 severity was assessed using the NEWS2 score. Disease outcome was threefold and regarded as discharged, patients who required mechanical ventilation (MV), and deceased patients. Results: MAFLD prevalence was 42%, 67% of patients were discharged, and 19% needed MV. Mortality rate was 14%. MAFLD patients were significantly younger (p < 0.001), and had higher body mass index (p < 0.05), respiratory rate (p < 0.05) and systolic blood pressure (p < 0.05) than nonMAFLD patients. Regarding metabolic syndrome and inflammatory markers: group A had significantly higher glycemia at admission (p = 0.008), lower HDL-c (p < 0.01), higher triglycerides (p < 0.01), CRP (p < 0.001), IL-6 (p < 0.05) and ferritin (p < 0.05) than group B. MAFLD was associated with more prevalent type 2 diabetes (p = 0.035) and hypertension (p < 0.05). MAFLD patients had a more severe disease course (NEWS2 score, 6.5 ± 0.5 vs. 3 ± 1.0, p < 0.05). MAFLD presence was associated with lower patient discharge (p < 0.01) and increased need for MV (p = 0.024). Multiple regression analysis showed that BMI (p = 0.045), IL-6 (p = 0.03), and MAFLD (p < 0.05) are significant independent risk factors for a poor COVID-19 outcome. Conclusions: The prevalence of MAFLD is relatively high. MAFLD patients had a more severe COVID-19 clinical course and worse disease outcome. Our results imply that early patient stratification and risk assessment are mandatory in order to avoid poor outcomes.

Combination of Chinese herbal medicine and conventional western medicine for coronavirus disease 2019: a systematic review and meta-analysis

Objective

This study aimed to assess the efficacy and safety of Chinese herbal medicine (CHM) plus conventional western medicine (CWM) in comparison with CWM against COVID-19.

Methods

We searched eight electronic databases and three trial registers spanning from January 1, 2020 to May 18, 2023. We included randomized controlled trials (RCTs) comparing the effectiveness and safety of CHM plus CWM and CWM against COVID-19 in our study. The Cochrane Risk of Bias tool 2.0 (RoB2) was applied to evaluate the methodological quality of the included RCTs. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was employed to assess the certainty of evidence. Statistical analysis was implemented in R version 4.1.2.

Results

Our study included 50 RCTs involving 11,624 patients. In comparison with sole CWM, CHM plus CWM against COVID-19 significantly enhanced clinical effective rate (RR = 1.18, 95% CI [1.13, 1.22]), improved chest image (RR = 1.19, 95% CI [1.11, 1.28]), inhibited clinical deterioration (RR = 0.45, 95% CI [0.33, 0.60]), lowered mortality (RR = 0.53, 95% CI [0.40, 0.70]), and reduced the total score of TCM syndrome (SMD = -1.24, 95% CI [-1.82, -0.66]). SARS-CoV-2 nucleic acid conversion time (MD = -2.66, 95% CI [-3.88, -1.44]), duration of hospitalization (MD = -2.36, 95% CI [-3.89, -0.82]), and clinical symptom (fever, cough, fatigue, and shortness of breath) recovery times were shorter in CHM plus CWM groups than in CWM groups. Further, CHM plus CWM treatment was more conducive for some laboratory indicators returning to normal levels. No statistical difference was found in the incidence of total adverse reactions between the two groups (RR = 0.97, 95% CI [0.88, 1.07]). We assessed the risk of bias for 246 outcomes, and categorized 55 into "low risk", 151 into "some concerns", and 40 into "high risk". Overall, the certainty of the evidence ranged from moderate to very low.

Conclusions

Potentially, CHM listed in this study, as an adjunctive therapy, combining with CWM is an effective and safe therapy mode for COVID-19. However, more high-quality RCTs are needed to draw more accurate conclusions.

Clinical trial registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=293963.

The impact of COVID-19 on national program of colorectal cancer screening in Tehran, Iran: a multicenter study

BACKGROUND

The COVID-19 pandemic has affected all aspects of the healthcare system, including prevention, treatment, rehabilitation of diseases and health education; access to essential therapies; allocation of finance & facilities to health issues, and governance of diseases, including COVID-19 and other diseases. Consequently, the burden of COVID-19 was not only attributable to the multiorgan involvement and detailed presentation of the disease but also to the inadequate management of other diseases resulting from the exclusive allocation of resources and medical personnel to the pandemic crisis. Over the mentioned period, one observed deficiency was the lack of public and official favor for conventional screening protocols. To this end, this study aims to evaluate the impact of the COVID-19 pandemic on colorectal cancer (CRC) screening protocols at Shahid Beheshti University of Medical Sciences in Tehran, Iran, in an effort to identify individuals at risk for CRC and provide them with intensive screening and therapy.

METHODS

This is an observational study comparing the number of candidates for CRC screening referred to primary, secondary, and tertiary health-care centers under supervision of Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran in a 2-year interval before and after COVID-19 pandemics. Patients with intermediate- and high-risk criteria for colorectal cancer were included in the study and were screened by fecal immunochemical test. Patients with positive or indeterminate fecal test results were further evaluated with colonoscopy in research institute for gastroenterology and liver diseases where is a tertiary referral center for CRC screening. Finally, the decrease percentage of screening tests and endoscopic findings during the pandemic period compared to pre-pandemic period was calculated and interpreted.

RESULTS

A significant decrease in the number of performed fecal immunochemical tests (FITs), referred positive FITs, and referred patients with positive alarm signs to the Research Institute of Gastroenterology and Liver Diseases (RIGLD) center inevitably led to a considerable decrease in the number of endoscopic findings, including high-risk adenomas, sessile serrated polyps, and even early-stage colorectal cancers (CRCs).

CONCLUSION

The disruption of screening protocols caused by the COVID-19 pandemic appears to increase the number of patients with high-grade and end-stage CRCs referred in the near future.

A Cross-Sectional Study of Fibromyalgia and Post-acute COVID-19 Syndrome (PACS): Could There Be a Relationship?

Background Post-acute COVID-19 syndrome (PACS) is a syndrome characterized by a wide spectrum of symptoms emerging after clearance of coronavirus 2019 (COVID-19) infection. These symptoms include fatigue, myalgia, arthralgia, cognitive dysfunction, and many other psychiatric symptoms. Given that fibromyalgia patients have similar symptoms, we conducted a web-based cross-sectional study to investigate the prevalence and predictors of fibromyalgia patients who recovered from COVID-19. Methods Data were collected between the 9th and 19th of March 2022 using a web-based survey. The questionnaire consisted of 25 questions gathering sociodemographic information, comorbid diseases and features of acute COVID-19 infection. Lastly, the American College of Rheumatology (ACR) survey criteria completed the questionnaire. Results A final sample of 404 individuals (75% women) filled out the form. Of these, 80 (19.8%) satisfied the ACR survey criteria for fibromyalgia (93.8% women). A multivariate logistic regression model including demographic and clinical factors showed that female gender (OR: 6.557, 95% CI: 2.376 - 18.093, p = 0.001) and dyspnea (OR: 1.980, 95% CI: 1.146 - 3.420, p = 0.014) were the strongest predictors of being classified as having post-COVID-19 fibromyalgia. Bivariate correlation revealed that age (r = 0.200, p = 0.001) and duration of COVID-19 infection (r = 0.121, p = 0.015) were directly correlated with fibromyalgia symptom (FS) score. Conclusion Our data suggest that clinical features of fibromyalgia are common in patients who recovered from COVID-19 and that dyspnea and female gender increase the risk of developing post-COVID-19 fibromyalgia.

COVID-19 Vaccine Hesitancy: A Global Public Health and Risk Modelling Framework Using an Environmental Deep Neural Network, Sentiment Classification with Text Mining and Emotional Reactions from COVID-19 Vaccination Tweets

Popular social media platforms, such as Twitter, have become an excellent source of information with their swift information dissemination. Individuals with different backgrounds convey their opinions through social media platforms. Consequently, these platforms have become a profound instrument for collecting enormous datasets. We believe that compiling, organizing, exploring, and analyzing data from social media platforms, such as Twitter, can offer various perspectives to public health organizations and decision makers in identifying factors that contribute to vaccine hesitancy. In this study, public tweets were downloaded daily from Tweeter using the Tweeter API. Before performing computation, the tweets were preprocessed and labeled. Vocabulary normalization was based on stemming and lemmatization. The NRCLexicon technique was deployed to convert the tweets into ten classes: positive sentiment, negative sentiment, and eight basic emotions (joy, trust, fear, surprise, anticipation, anger, disgust, and sadness). t-test was used to check the statistical significance of the relationships among the basic emotions. Our analysis shows that the p-values of joy-sadness, trust-disgust, fear-anger, surprise-anticipation, and negative-positive relations are close to zero. Finally, neural network architectures, including 1DCNN, LSTM, Multiple-Layer Perceptron, and BERT, were trained and tested in a COVID-19 multi-classification of sentiments and emotions (positive, negative, joy, sadness, trust, disgust, fear, anger, surprise, and anticipation). Our experiment attained an accuracy of 88.6% for 1DCNN at 1744 s, 89.93% accuracy for LSTM at 27,597 s, while MLP achieved an accuracy of 84.78% at 203 s. The study results show that the BERT model performed the best, with an accuracy of 96.71% at 8429 s.

The Incidence and Severity of COVID-19 Infection Post Vaccination in Saudi Arabia

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19). Presently, there is ongoing continuous research for more therapeutic options with a wide variety of vaccine availability. However, many people have worried about the vaccine's side effects. Hence, the current study was conducted to determine the prevalence of vaccinated individuals, side effects, and the rate of infectivity post vaccination including the three doses of vaccinations. Methods A cross-sectional questionnaire-based survey was conducted using Google Forms (Google, Inc., Mountain View, CA). Five hundred forty-three individuals participated and reported their status of COVID-19 infection, vaccination, and side effects. All the participants from Saudi Arabia received all the vaccine shots including the booster dose. Results Most of the Saudi nationals were fully vaccinated, and most received Pfizer vaccines for their first and second shots. Pain at the injection site was reported as the most common adverse effect followed by fever, headache, fatigue, and joint pain. Conclusion From the findings, it is concluded that most of the population of Saudi Arabia was vaccinated effectively. Pain at the injection site is identified as the primary adverse effect of vaccination. Most of the population is vaccinated with the Pfizer vaccine. Long-term side effect monitoring is recommended with large population studies to confirm the status of vaccines and adverse effects.

Stress, Anxiety, and Depression Levels among University Students: Three Years from the Beginning of the Pandemic

BACKGROUND

Three years after the outbreak of the COVID-19 pandemic, psychological distress among college students remains increased. This study assesses stress, anxiety, and depression levels among students of the Aristotle University of Thessaloniki by the end of the third year of the pandemic (November 2022), revealing demographic characteristics and probable stressors.

METHODS

A questionnaire was distributed in November 2022 via the academic students' e-mails. The evaluation was performed with the DASS21 survey tool. The correlation analysis and the effect size calculation were performed with the t-test.

RESULTS

The majority of participants were undergraduates, on their first or second academic year, female students (67%), age of 18 to 21, unmarried or single (91%), and vaccinated against COVID-19 infection (83.4%). Severely increased levels of stress, anxiety, and depression (21.3%, 23.3%, and 25.1%, respectively) were measured. The normal and mild levels of stress, anxiety, and depression were 64.0%, 66.5%, and 57.2%, respectively. Female and younger students were at a higher risk of extremely severe stress, anxiety and depression prevalence (ORs up to 2.07, p-Values < 0.00001). Participants who were receiving psychological or psychiatric treatment exhibited severe stress, anxiety, and depression levels (ORs above 2.9, p-Values < 0.00001).

CONCLUSIONS

Despite the undeniable withdrawal of the COVID-19 pandemic, the community of the Aristotle University of Thessaloniki presents high stress, anxiety, and depression levels, similar to those reported during the first year of the pandemic (November 2020). Stressors and risk factors were according to the reported literature and previous studies on Greek students. Academic psychological support offices should consider the students' "profile" in order to evaluate properly the potential risk for emotional and psychological distress. Evidence suggest that new technology (virtual reality, tele-psychiatry or tele-support apps and sessions) should also be implemented in universities.

A Case of Acute Kidney Injury Caused by Myoglobin Cast Nephropathy With Sars-Cov-2 Infection in a Living-Donor Kidney Transplant Recipient

When COVID-19 affects patients with risk factors such as chronic kidney disease or on immunosuppressive drugs, they often rapidly become seriously ill. We describe a 50-year-old man who was affected with SARS-CoV-2 and had undergone an ABO-compatible living-donor kidney transplantation from his father 14 years ago because of end-stage renal failure due to hypertensive nephrosclerosis. He had continued on immunosuppressive drugs and completed vaccination twice (9 months ago and 6 months ago) with messenger RNA (mRNA) vaccines against SARS-CoV-2. However, he was temporarily on a mechanical ventilator due to respiratory failure and hemodialysis due to acute kidney injury (AKI). He was finally weaned from the ventilator and hemodialysis by taking steroid and antiviral drugs. Echo-guided renal biopsy revealed myoglobin cast nephropathy. We experienced 14 outpatients after living-donor kidney transplantation infected with SARS-CoV-2, but only this case developed AKI.

Determinants Influenced by COVID-19 Vaccine: Employing the Health Action Process Approach and the Belief in Conspiracy Theories

Vaccination is considered a practical approach to improving individuals’ health behavior to fight against the COVID-19 pandemic. However, the currently manufactured COVID-19 vaccines can only work for a limited time. Thus, continuous vaccination intention is crucially essential. The current study explores critical factors influencing citizens’ continuous vaccination intentions for COVID-19 vaccines, based on the modified health action process approach (HAPA) model and belief in a conspiracy theory. A questionnaire survey was used to collect data from people living in Taiwan. Three hundred ninety responses were employed for the final investigation. The findings suggest that openness to experience, government communication, and pandemic knowledge significantly influence vaccination intention, but the COVID-19 threat is insignificant. Second, descriptive norms play a significant role in promoting vaccination intention. Third, a belief in conspiracy theories negatively influences vaccination intention. Fourth, vaccination behavior positively influences both perceived benefits and value co-creation. Fifth, perceived benefits positively impact value co-creation and continuous vaccination behavior. Finally, value co-creation has a significant influence on continuous vaccination behavior. The proposed model, the key contributor to the current study, confirms citizens’ continuous vaccination intentions in a three-stage procedure: motivation to volitional, volitional to behavior, and volitional to continuous vaccination intention.

Association between Body Mass Index and Hospital Outcomes for COVID-19 Patients: A Nationwide Study

BACKGROUND

Coronavirus disease 2019 (COVID-19) caused significant morbidity and mortality worldwide. There is limited information describing the hospital outcomes of COVID-19 patients in regard to specific body mass index (BMI) categories.

METHODS

We utilized the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) 2020 database to collect information on patients hospitalized for COVID-19 in the United States. Using the International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) coding system, adult patients (≥18 years of age) with a primary hospitalization for COVID-19 were identified. Adjusted analyses were performed to assess for mortality, morbidity, and resource utilization, and compare the outcomes among patients categorized according to BMI.

RESULTS

A total of 305,284 patients were included in this study. Of them, 248,490 had underlying obesity, defined as BMI ≥ 30. The oldest patients were observed to have BMI < 19, while youngest patients were in the BMI > 50 category. BMI < 19 category had the highest crude in-hospital mortality rate. However, after adjusted regression, patients with BMI > 50 (adjusted odds ratio (aOR) 1.63, 95% CI 1.48-1.79, p-value < 0.001) had the highest increased odds, at 63%, of in-hospital mortality compared to all other patients in the study. Patients with BMI > 50 also had the highest increased odds of needing invasive mechanical ventilation (IMV) and mortality associated with IMV compared to all other patient, by 37% and 61%, respectively. Obese patients were noted to have shorter average hospital length of stay (LOS), by 1.07 days, compared to non-obese patients, but there was no significant difference in average hospitalization charges.

CONCLUSION

Among obese patients primarily hospitalized with COVID-19, those with BMI ≥ 40 had significantly increased rates of all-cause in-hospital mortality, need for IMV, mortality associated with IMV, and septic shock. Overall, obese patients had shorter average hospital LOS, however, did not have significantly higher hospitalization charges.

Obesity-Associated Hepatic Steatosis, Somatotropic Axis Impairment, and Ferritin Levels Are Strong Predictors of COVID-19 Severity

The full spectrum of SARS-CoV-2-infected patients has not yet been defined. This study aimed to evaluate which parameters derived from CT, inflammatory, and hormonal markers could explain the clinical variability of COVID-19. We performed a retrospective study including SARS-CoV-2-infected patients hospitalized from March 2020 to May 2021 at the Umberto I Polyclinic of Rome. Patients were divided into four groups according to the degree of respiratory failure. Routine laboratory examinations, BMI, liver steatosis indices, liver CT attenuation, ferritin, and IGF-1 serum levels were assessed and correlated with severity. Analysis of variance between groups showed that patients with worse prognoses had higher BMI and ferritin levels, but lower liver density, albumin, GH, and IGF-1. ROC analysis confirmed the prognostic accuracy of IGF-1 in discriminating between patients who experienced death/severe respiratory failure and those who did not (AUC 0.688, CI: 0.587 to 0.789, p < 0.001). A multivariate analysis considering the degrees of severity of the disease as the dependent variable and ferritin, liver density, and the standard deviation score of IGF-1 as regressors showed that all three parameters were significant predictors. Ferritin, IGF-1, and liver steatosis account for the increased risk of poor prognosis in COVID-19 patients with obesity.

In Search of an Efficient and Reliable Deep Learning Model for Identification of COVID-19 Infection from Chest X-ray Images

The virus responsible for COVID-19 is mutating day by day with more infectious characteristics. With the limited healthcare resources and overburdened medical practitioners, it is almost impossible to contain this virus. The automatic identification of this viral infection from chest X-ray (CXR) images is now more demanding as it is a cheaper and less time-consuming diagnosis option. To that cause, we have applied deep learning (DL) approaches for four-class classification of CXR images comprising COVID-19, normal, lung opacity, and viral pneumonia. At first, we extracted features of CXR images by applying a local binary pattern (LBP) and pre-trained convolutional neural network (CNN). Afterwards, we utilized a pattern recognition network (PRN), support vector machine (SVM), decision tree (DT), random forest (RF), and k-nearest neighbors (KNN) classifiers on the extracted features to classify aforementioned four-class CXR images. The performances of the proposed methods have been analyzed rigorously in terms of classification performance and classification speed. Among different methods applied to the four-class test images, the best method achieved classification performances with 97.41% accuracy, 94.94% precision, 94.81% recall, 98.27% specificity, and 94.86% F1 score. The results indicate that the proposed method can offer an efficient and reliable framework for COVID-19 detection from CXR images, which could be immensely conducive to the effective diagnosis of COVID-19-infected patients.

Covid-19 vaccine hesitancy: Text mining, sentiment analysis and machine learning on COVID-19 vaccination Twitter dataset

In 2019 there was an outbreak of coronavirus pandemic also known as COVID-19. Many scientists believe that the pandemic originated from Wuhan, China, before spreading to other parts of the globe. To reduce the spread of the disease, decision makers encouraged measures such as hand washing, face masking, and social distancing. In early 2021, some countries including the United States began administering COVID-19 vaccines. Vaccination brought a relief to the public; it also generated a lot of debates from anti-vaccine and pro-vaccine groups. The controversy and debate surrounding COVID-19 vaccine influenced the decision of several people in either to accept or reject vaccination. Because of data limitations, social media data, collected through live streaming public tweets using an Application Programming Interface (API) search, is considered a viable and reliable resource to study the opinion of the public on Covid-19 vaccine hesitancy. Thus, this study examines 3 sentiment computation methods (Azure Machine Learning, VADER, and TextBlob) to analyze COVID-19 vaccine hesitancy. Five learning algorithms (Random Forest, Logistics Regression, Decision Tree, LinearSVC, and Naïve Bayes) with different combination of three vectorization methods (Doc2Vec, CountVectorizer, and TF-IDF) were deployed. Vocabulary normalization was threefold; potter stemming, lemmatization, and potter stemming with lemmatization. For each vocabulary normalization strategy, we designed, developed, and evaluated 42 models. The study shows that Covid-19 vaccine hesitancy slowly decreases over time; suggesting that the public gradually feels warm and optimistic about COVID-19 vaccination. Moreover, combining potter stemming and lemmatization increased model performances. Finally, the result of our experiment shows that TextBlob + TF-IDF + LinearSVC has the best performance in classifying public sentiment into positive, neutral, or negative with an accuracy, precision, recall and F1 score of 0.96752, 0.96921, 0.92807 and 0.94702 respectively. It means that the best performance was achieved when using TextBlob sentiment score, with TF-IDF vectorization and LinearSVC classification model. We also found out that combining two vectorizations (CountVectorizer and TF-IDF) decreases model accuracy.

The Psychological Morbidity among Health Care Workers During the Early Phase of Covid-19 Pandemic in India: A Systematic Review and Meta-Analysis

Across India, there have been multiple studies conducted to address the issues of the mental health of healthcare workers during the COVID-19 pandemic. The present study estimated the pooled prevalence of psychological morbidity among healthcare workers during the early phase of the COVID 19 pandemic in India. We searched the following electronic bibliographic databases: PubMed, ScienceDirect, Wiley online library, and Google scholar for studies conducted from the onset of the COVID 19 pandemic until 25 September 2021. The methodological quality of each study was scored and outcome measures with uniform cut off scores as per various screening measurements were evaluated. According to the current meta analysis, the pooled estimates of depression, anxiety, stress, and insomnia among Indian healthcare workers during the COVID 19 pandemic are 20.1% (95% CI: 15.6 to 24.6%; n = 21 studies), 25.0% (95% CI: 18.4 to 31.6%; n = 20 studies), 36% (95% CI: 23.7 to 48.2%; n = 22 studies) and 18.9% (95% CI: 9.9 to 28.0%; n = 6 studies) respectively. In subgroup analyses, low quality studies based on the JBI checklist (Score < 3/9) and studies using DASS 21 showed a higher pooled prevalence of depression and anxiety. About 20-36% of the healthcare workers in India reported having depression, anxiety, and stress during the early phase of the COVID 19 pandemic. The present study provides a comprehensive review of the overall burden of mental health problems among healthcare workers during the COVID 19 pandemic in India necessitating appropriate intervention strategies to protect these frontline groups before the memory of the pandemic crisis starts to fade.

Subdural empyema in immunocompetent pediatric patients with recent SARS-CoV-2 positivity: case report

Subdural empyema refers to the collection of purulent material in the subdural space and the most source of it is bacterial meningitis in infants while sinusitis and otitis media in older children. It has been very recently reported that coronaviruses (CoV) exhibit neurotropic properties and may also cause neurological diseases. CoV-related complications as hypercoagulability with thrombosis and associated inflammation, catastrophic cerebral venous sinus thrombose sand bacterial-fungal superinfections have been well documented in adult patients. Hereby, we describe 15-year-old and 12-year-old female children with subdural empyema after SARS-CoV2. The patients presented limitation of eye in the outward gaze, impaired speech, drowsiness, fever, vomiting and they also were tested positive for COVID-19. MRI indicated subdural empyema and surgical interventions were needed to relieve intracranial pressure and drain pus after receiving broad spectrum antibiotics treatments. The microbiological analysis of abscess material revealed Streptococcus constellatus which is extremely rare in an immunocompetent child and the patients received appropriate IV antibiotic therapy. Eventually, patients became neurologically intact. Pediatric patients with CoV infections should be closely monitored for neurological symptoms. Further research and more data on the correlation between CoV infections would provide better recognition and treatment options in an efficient manner in children.

Endothelial Monocyte-Activating Polypeptide-II Is an Indicator of Severity and Mortality in COVID-19 Patients

Data for predicting the severity and mortality of coronavirus disease 2019 (COVID-19) are limited, and investigations are ongoing. Endothelial monocyte-activating protein II (EMAP-II) is a multifunctional polypeptide with pro-inflammatory properties. EMAP-II is a significant pathogenic component in chronic inflammatory lung diseases and lung injury. In this study, we aimed to assess the potential utility of EMAP-II as a predictor of COVID-19 severity and mortality. This study included 20 healthy volunteers and 60 verified COVID-19 patients. Nasopharyngeal samples from COVID-19-positive subjects and normal volunteers were collected at admission. The nasopharyngeal samples were subjected to EMAP-II real-time polymerase chain reaction (RT-PCR). EMAP-II RNA was not detected in nasopharyngeal swabs of normal controls and mild to asymptomatic COVID-19 patients and was only detectable in severe COVID-19 patients. EMAP-II critical threshold (Ct) was positively associated with lymphocyte percentages and oxygen saturation (p < 0.001) while being negatively associated with age (p = 0.041), serum CRP, ferritin, and D-dimer levels (p < 0.001). EMAP-II Ct cutoff ≤34 predicted a worse outcome in COVID-19 illness, with a sensitivity and specificity of 100%. Our study suggests that EMAP-II could be considered a potential biomarker of COVID-19 severity. EMAP-II can predict the fatal outcome in COVID-19 patients.

COVID-19 and Semen Fluid Parameters, a Retrospective Study from Infertility Clinics

The study of the effects of SARS-CoV-2 infection and/or vaccination on semen fluid analysis (SFA) parameters is still incomplete. The aim of this study is to assess the effect of COVID-19 infection and vaccination on sperm parameters for a sample of individuals visiting multi-infertility clinics in Jordan. SFA records were collected retrospectively between September and November 2021 and analyzed using Jamovi software (version 2.2.5 for Windows); p-values < 0.05 were considered statistically significant. Sperm concentration, progressive motility, normal morphology, and semen liquefaction time, volume, and viscosity were compared among two data categories. In the first category of data, SFA records from 354 participants were separated into four groups: only vaccinated, infected and vaccinated, neither infected nor vaccinated, and only infected. In the other category, SFA from 49 subjects before their infection and/or vaccination and after were classified into the same mentioned groups and analyzed. There were no statistically significant differences between the studied parameters in the SFA records in the first data category and the second. Nevertheless, the sperm concentration was higher among vaccinated subjects compared to unvaccinated ones (p = 0.04). It is concluded that SARS-CoV-2 infection and vaccines have no negative effects on SFA parameters.

Role of bioaerosol in virus transmission and material-based countermeasures

Respiratory pathogens transmit primarily through particles such as droplets and aerosols. Although often overlooked, the resuspension of settled droplets is also a key facilitator of disease transmission. In this review, we discuss the three main mechanisms of aerosol generation: direct generation such as coughing and sneezing, indirect generation such as medical procedures, and resuspension of settled droplets and aerosols. The size of particles and environmental factors influence their airborne lifetime and ability to cause infection. Specifically, humidity and temperature are key factors controlling the evaporation of suspended droplets, consequently affecting the duration in which particles remain airborne. We also suggest material-based approaches for effective prevention of disease transmission. These approaches include electrostatically charged virucidal agents and surface coatings, which have been shown to be highly effective in deactivating and reducing resuspension of pathogen-laden aerosols.

Computational and comparative investigation of hydrophobic profile of spike protein of SARS-CoV-2 and SARS-CoV

The hydrophobic force is one of the most dominant factors in protein folding. A protein becomes functional only when it achieves its three-dimensional structure and stability upon folding. For a better understanding of the hydrophobic effects and their function in protein folding, quantitative measurement of the hydrophobicity of amino acid side chains is crucial. Spike protein is the primary structural protein in SARS-CoV-2 and SARS-CoV. This study explores how protein sequences in SARS-CoV-2 and SARS-CoV spike proteins encode hydrophobic interactions. Computational tools/techniques have been utilized to investigate the protein sequences of the spike proteins of SARS-CoV-2 and SARS-CoV. Investigations provided an estimate of hydrophobic distribution and its relative strength, indicating a hydrophobic pattern. Analysis of the spike protein's hydrophobic profile may help identify and treat the virus-caused disease; additionally, it can give an insight into the transmissibility and pathogenicity of the virus.

A systematic review assessing the effectiveness of COVID-19 mRNA vaccines in chronic kidney disease (CKD) individuals

Background: SARS-CoV-2 is a coronavirus that has rapidly spread across the world with a detrimental effect on the global population. Several reports have highlighted an increased mortality rate and a higher severity of COVID-19 infection in chronic kidney disease (CKD) individuals. Upon the development of various SARS-CoV-2 vaccines, mRNA vaccines including BNT162b2 and mRNA-1273 were deemed safe, with a high efficacy in preventing COVID-19 in the general population. This review investigates whether  SARS-CoV-2 mRNA vaccines are as effective in triggering an immune response in Dialysis Patients (DPs) and Kidney Transplant Recipients (KTRs) and if a third dose is required in this  population. Methods: A systematic search employing the PRISMA criteria was conducted in several major databases, with the data being extracted from publications for the period January 2021 to May 2022 (PROSPERO: CRD42022338514, June 15, 2022). Results: 80 studies were included in this analysis with a total cohort number of 15,059 participants. Overall, 85.29% (OR = 17.08, 95% CI = 15.84-18.42, I ² = 98%) and 41.06% (OR = 0.52, 95% CI = 0.48-0.5, I ² = 95%) of DPs and KTRs included in this review showed positive seroconversion after two doses of either mRNA vaccine, respectively. A total 76% (OR = 6.53, 95% CI = 5.63-7.5, I ² = 96%) of the cohort given a third dose of an mRNA vaccine demonstrated positive seroconversion, with 61.86% (OR = 2.31, 95% CI = 1.95-2.75 I ² = 95%) of the cohort that was assessed for a cellular response displaying a positive response. Conclusions: This data emphasises a reduced incidence of a positive immune response in DPs and KTRs compared to healthy controls, albeit a better response in DPs than when compared to KTRs alone was observed. A third dose  appears to increase the occurrence of an immune response in the overall DP/KTR cohort.

Omicron BA.2.75 Sublineage (Centaurus) Follows the Expectations of the Evolution Theory: Less Negative Gibbs Energy of Biosynthesis Indicates Decreased Pathogenicity

SARS-CoV-2 belongs to the group of RNA viruses with a pronounced tendency to mutate. Omicron BA.2.75 is a subvariant believed to be able to suppress the currently dominant BA.5 and cause a new winter wave of the COVID-19 pandemic. Omicron BA.2.75 is characterized by a greater infectivity compared to earlier Omicron variants. However, the Gibbs energy of the biosynthesis of virus particles is slightly less negative compared to those of other variants. Thus, the multiplication rate of Omicron BA.2.75 is lower than that of other SARS-CoV-2 variants. This leads to slower accumulation of newly formed virions and less damage to host cells, indicating evolution of SARS-CoV-2 toward decreasing pathogenicity.

Online Clinical Briefing for Radiologic Technology Students in Covid-19 Pandemic Outbreak: Efficiency, Application, and Feedback of Students

OBJECTIVE

To evaluate students' satisfaction and efficacy of online clinical briefing for radiologic technology students. The study aimed to evaluate the efficiency, the possibility of application, and students' feedback with the new form of clinical briefing during the COVID-19 pandemic outbreak.

METHODS

A cross-sectional survey was conducted on 120 full-time radiologic technology students after participating in online clinical briefing sessions at the Department of Radiology, Hue University of Medicine and Pharmacy Hospital. This training approach was implemented for students from April to July 2021. During the briefing, participants were asked to discuss on cases that were prepared by the previous on-duty nightshift students with the consultant of the senior staff. The discussion focused on the technical aspects, challenges, and clinical implementation of each technique. Descriptive statistics were used to analyze the responses of students using the Likert scale (1. Complete disagree, 2. Disagree, 3. Satisfy, 4. Partial agree, 5. Complete agree).

RESULTS

Our findings show that 76.5% of students were very satisfied and/or satisfied with the online clinical briefing. In particular, the mean score for satisfaction with teaching resources and platforms, and assessment tools were 4.21; less fear in giving feedback than on-site briefings were 3.57; satisfaction with faculty accessibility and availability in giving feedback as well as answering questions for students was 4.29; satisfaction with student's performance and final grade was 3.55. 94.2% of students were willing to continue studying online during the COVID-19 breakout or similar circumstances.

CONCLUSION

Online clinical briefing is an appropriate teaching approach during a prolonged COVID-19 breakout. However, it cannot completely replace traditional teaching methods in providing essential clinical skills for radiologic technology students due to the unique characteristics of medicine and medical imaging teaching which require a substantial amount of clinical practice.

Distribution of Viral Respiratory Infections during the COVID-19 Pandemic Using the FilmArray Respiratory Panel

This study was conducted to evaluate the distribution of respiratory viral pathogens in the emergency department during the coronavirus disease 2019 (COVID-19) pandemic. Between May 2020 and September 2022, patients aged between 0.1 and 98 years arrived at the emergency department of Asia University Hospital, and samples from nasopharyngeal swabs were tested by the FilmArrayTM Respiratory Panel (RP). SARS-CoV-2 positivity was subsequently retested by the cobas Liat system. There were 804 patients for whom the FilmArrayTM RP was tested, and 225 (27.9%) of them had positive results for respiratory viruses. Rhinovirus/enterovirus was the most commonly detected pathogen, with 170 (61.8%) cases, followed by adenovirus with 38 (13.8%), SARS-CoV-2 with 16 (5.8%) cases, and coronavirus 229E, with 16 (5.8%) cases. SARS-CoV-2 PCR results were positive in 16 (5.8%) cases, and there were two coinfections of SARS-CoV-2 with adenovirus and rhinovirus/enterovirus. A total of 43 (5.3%) patients were coinfected; the most coinfection was adenovirus plus rhinovirus/enterovirus, which was detectable in 18 (41.9%) cases. No atypical pathogens were found in this study. Intriguingly, our results showed that there was prefect agreement between the detection of SARS-CoV-2 conducted with the cobas Liat SARS-CoV-2 and influenza A/B nucleic acid test and the FilmArrayTM RP. Therefore, the FilmArrayTM RP assay is a reliable and feasible method for the detection of SARS-CoV-2. In summary, FilmArrayTM RP significantly broadens our capability to detect multiple respiratory infections due to viruses and atypical bacteria. It provides a prompt evaluation of pathogens to enhance patient care and clinical selection strategies in emergency departments during the COVID-19 pandemic.

Prevalence of anxiety and depressive symptoms during COVID-19 pandemic among the general population in India: A systematic review and meta-analysis

Objective

The novel coronavirus (n COVID-19) has affected every walk of life across the world including India. Several studies have been available on the COVID-19-related anxiety and depressive symptoms in the public health context. However, there is a dearth of evidence of a meta-analysis regarding the pooled estimates of anxiety and depressive symptoms related to this pandemic based on the existing studies conducted among the general population of India. The aim of the study was to estimate the pooled prevalence of COVID-19-related anxiety and depressive symptoms among the general population in India.

Material and Methods

We searched the following electronic bibliographic databases: PubMed, Ovid, Science Direct, and Wiley online library for studies conducted from the onset of the COVID-19 pandemic and until September 25, 2021. We separately analyzed the outcome measures based on the risk of bias assessment. The publication bias was evaluated by funnel plots and Egger's test.

Results

We used a random-effect model due to the significant heterogeneity between the studies (Anxiety symptoms - I2 = 99.40% and Depressive symptoms - I2 = 95.3%). According to the index meta-analysis, the pooled estimates of anxiety and depressive symptoms among general population of India during COVID-19 pandemic are 23.5% (95% CI: 17.4-29.6%; n = 21 studies) and 20.2% (95% CI: 17.2-23.2%; n = 17 studies), respectively. In subgroup analyses, good-quality studies (Score ≥7/9) had a significant effect on the pooled prevalence.

Conclusion

About one-fifth of the general population of India reported having anxiety and depressive symptoms during the COVID-19 pandemic. The pooled estimates varied with the methodological quality of included studies. The present study provides a comprehensive picture of the overall magnitude of anxiety and depressive symptoms due to the COVID-19 outbreak which will guide the policy makers to measure the burden of similar pandemics more judiciously in the future.

Determining Required Teaching Methods in Distance Undergraduate Medical Education Based on the Non-University Learning Methods Medical Students Used During Covid-19: An Exploratory Factor Analysis

In order to improve the distance learning experience for undergraduate medical education, this study aims to evaluate the teaching methods used by universities in Jordan during the distance learning period and identify the best methods in this situation based on non-university educational avenues utilized by medical students during COVID-19. We conducted a survey of 195 medical students from universities across the country using a questionnaire that measures how dependent students are on educational resources provided by universities before and during the distance learning condition and looks into medical students' most used non-university learning methods in face-to-face and distance learning conditions, and the extent to which medical students used them. We found that the main methods used by medical students for non-university learning were non-university educational videos like YouTube videos (92.8%) and non-university textual explanations (i.e., explanations on websites and summaries of materials made by other students) (67.7%). Before the remote learning situation, there was a large reliance on non-university learning materials, which rose significantly during the distance learning situation (p<0.001, r=0.54). We conducted a polychoric correlations-based Exploratory Factor Analysis (EFA) on 10 items, 7 of which were retained in the final model that revealed 2 factors, to analyze the relationship between the universities' educational methods used in distance learning and the non-university methods medical students used. The first factor reflected the change in "students' use of non-university visualization learning methods in distance learning" (external videos, general dependence on non-university methods, and simulation apps had the highest significant loadings (>0.3)). The second factor reflected the change in "universities' use of visualization and interactive learning methods in distance learning" (deductive discussions, educational videos, and practical methods had significant loadings). A moderately negative correlation was detected between the two factors after applying a Promax rotation (r=-0.41), indicating that the decrease in universities' use of visualization and interactive learning aids in connection with insufficient visualization in the distance educational sessions increased students' use of the aforementioned visualized learning methods in distance learning. This study identifies the optimal visual teaching aids to improve distance undergraduate medical education.

Community resilience to pandemics: An assessment framework developed based on the review of COVID-19 literature

The COVID-19 outbreak in 2019 and the challenges it posed to communities around the world, demonstrated the necessity of enhancing the resilience of communities to pandemics. In this regard, assessment frameworks can play an essential role and guide resilience-building efforts. However, the lack of a comprehensive assessment framework has led to a focus on sectoral evaluation. This study aims to propose an integrated framework for assessing the pandemic resilience of communities. For this purpose, we rely on a systematic review of literature indexed in major academic databases. We have thoroughly analyzed a total number of 115 related documents to extract relevant criteria. Findings show that many criteria and factors affect community resilience to pandemics. By inductive content coding in MAXQDA software, we have categorized these criteria into five dimensions of Institutional, Social, Economic, Infrastructural, and Demographic. Good leadership and management, insurance and governmental support, planning and preparation, expertise and labor, and available equipment and technologies are the most important institutional criteria. Communication and collective identity, mutual support, public safety and protection, public awareness, and social justice are the influential social criteria. Economic sustainability and resource availability are criteria of economic resilience. Sufficiency of services, public spaces, housing tenure, and transportation system are the main criteria related to the built environment and infrastructural dimension. Finally, demographic resilience includes physical health, psychological well-being, life quality, and hygiene. Based on these criteria, this study develops an integrated evaluation framework that researchers can implement along with conventional assessment and ranking methods to determine the level of community resilience to pandemics.

Evaluation of cardio-pulmonary functions of previously healthy adults with moderate-severe COVID-19 pneumonia after discharge

Aim: Persistent dyspnea is one of the most frequent post-COVID symptoms. We aimed to evaluate the cardiopulmonary functions of COVID-19 survivors with moderate to severe COVID-19 pneumonia without comorbidity, during the first wave of pandemics. Material and Method: The study was conducted retrospectively in a single center. The electronic data of patients applied with dyspnea one month after hospital discharge, without any comorbidities, and who were evaluated with pulmonary function test (PFT) and echocardiography were included in the study. A total of adult 88 patients who suffered from COVID-19 pneumonia (46 moderate and 42 severe) were enrolled. Results of biochemical, hematological and radiological examinations, PFT parameters and echocardiography were recorded and compared between moderate and severe cases. Results: The mean age of 88 patients included in the study was 48±13 years. Sixty-seven (74.4%) of the patients were male. Pulmonary thromboembolism was not detected in both groups. PFT parameters performed were similar in the two groups and there was no statistically significant difference. Pulmonary function test of the patients with moderate COVID-19 pneumonia revealed mild restriction in 21.7% and moderate restriction in 2% of the patients. In the severe group, 38.1% of the patients had mild and 4.8% of the patients had a moderate restrictive pattern. Small airway obstruction was detected in 37% of the moderate group and in 38.1% of the severe group. Conventional echocardiographic parameters of the two groups were normal. Pulmonary arterial pressures were 22.6±8.3 vs 22.1±6.8; p=0.8 was found. Tricuspid annular plane systolic excursion were within normal limits. Conclusıon: The persistent dyspnea following COVID-19 pneumonia may be related to disturbances in PFT even in patients without comorbidities. We concluded that; the detailed evaluation of the patients with prolonged respiratory symptoms might help to detect the cardiopulmonary functional disturbances.

Correlation between Type I Interferon Associated Factors and COVID-19 Severity

Antiviral type I interferons (IFN) produced in the early phase of viral infections effectively inhibit viral replication, prevent virus-mediated tissue damages and promote innate and adaptive immune responses that are all essential to the successful elimination of viruses. As professional type I IFN producing cells, plasmacytoid dendritic cells (pDC) have the ability to rapidly produce waste amounts of type I IFNs. Therefore, their low frequency, dysfunction or decreased capacity to produce type I IFNs might increase the risk of severe viral infections. In accordance with that, declined pDC numbers and delayed or inadequate type I IFN responses could be observed in patients with severe coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), as compared to individuals with mild or no symptoms. Thus, besides chronic diseases, all those conditions, which negatively affect the antiviral IFN responses lengthen the list of risk factors for severe COVID-19. In the current review, we would like to briefly discuss the role and dysregulation of pDC/type I IFN axis in COVID-19, and introduce those type I IFN-dependent factors, which account for an increased risk of COVID-19 severity and thus are responsible for the different magnitude of individual immune responses to SARS-CoV-2.

High-Flow Nasal Cannula Versus Noninvasive Ventilation in Patients With COVID-19

BACKGROUND

High-flow nasal cannula (HFNC) oxygen and noninvasive ventilation (NIV) have been widely used in patients with acute hypoxic respiratory failure (AHRF) due to COVID-19. However, the impact of HFNC versus NIV on clinical outcomes of COVID-19 is uncertain. Therefore, we performed this meta-analysis to evaluate the effect of HFNC versus NIV in COVID-19-related AHRF.

METHODS

Several electronic databases were searched through February 10, 2022, for eligible studies comparing HFNC and NIV in COVID-19-related AHRF. Our primary outcome was intubation. The secondary outcomes were mortality, hospital length of stay (LOS), and P_aO2 /F_IO2 changes. Pooled risk ratio (RR) and mean difference (MD) with the corresponding 95% CI were obtained using a random-effect model. Prediction intervals were calculated to indicate the variance in outcomes that would be expected if new studies were conducted in the future.

RESULTS

Nineteen studies involving 3,606 subjects (1,880 received HFNC and 1,726 received NIV) were included. There were no differences in intubation (RR 1.01 [95% CI 0.85-1.20], P = .89) or LOS (MD 0.38 d [95% CI -0.61 to 1.37], P = .45) between groups, with consistent results on the subgroup of randomized controlled trials (RCTs). Mortality was lower in NIV (RR 0.81 [95% CI 0.66-0.98], P = .03). However, the prediction interval was 0.41-1.59, and subgroup analysis of RCTs showed no difference in mortality between groups. There was a greater improvement in P_aO2 /F_IO2 with NIV (MD 22.80 [95% CI 5.30-40.31], P = .01).

CONCLUSIONS

Our study showed that despite the greater improvement in P_aO2 /F_IO2 with NIV, intubation rates and LOS were similar between HFNC and NIV. Although mortality was lower with HFNC than NIV, the prediction interval included the null value, and there was no difference in mortality between HFNC and NIV on a subgroup of RCTs. Future large-scale RCTs are necessary to support our findings.

Inhaled Pulmonary Vasodilators in COVID-19 Infection: A Systematic Review and Meta-Analysis

Introduction: Inhaled pulmonary vasodilators (IPVD) have been previously studied in patients with non-coronavirus disease-19 (COVID-19) related acute respiratory distress syndrome (ARDS). The use of IPVD has been shown to improve the partial pressure of oxygen in arterial blood (PaO₂), reduce fraction of inspired oxygen (FiO₂) requirements, and ultimately increase PaO₂/FiO₂ (P/F) ratios in ARDS patients. However, the role of IPVD in COVID-19 ARDS is still unclear. Therefore, we performed this meta-analysis to evaluate the role of IPVD in COVID-19 patients. Methods: Comprehensive literature search of PubMed, Embase, Web of Science and Cochrane Library databases from inception through April 22, 2022 was performed for all published studies that utilized IPVD in COVID-19 ARDS patients. The single arm studies and case series were combined for a 1-arm meta-analysis, and the 2-arm studies were combined for a 2-arm meta-analysis. Primary outcomes for the 1-arm and 2-arm meta-analyzes were change in pre- and post-IPVD P/F ratios and mortality, respectively. Secondary outcomes for the 1-arm meta-analysis were change in pre- and post-IPVD positive end-expiratory pressure (PEEP) and lung compliance, and for the 2-arm meta-analysis the secondary outcomes were need for endotracheal intubation and hospital length of stay (LOS). Results: 13 single arm retrospective studies and 5 case series involving 613 patients were included in the 1-arm meta-analysis. 3 studies involving 640 patients were included in the 2-arm meta-analysis. The pre-IPVD P/F ratios were significantly lower compared to post-IPVD, but there was no significant difference between pre- and post-IPVD PEEP and lung compliance. The mortality rates, need for endotracheal intubation, and hospital LOS were similar between the IPVD and standard therapy groups. Conclusion: Although IPVD may improve oxygenation, our investigation showed no benefits in terms of mortality compared to standard therapy alone. However, randomized controlled trials are warranted to validate our findings.

Has the COVID-19 pandemic affected the psychological state of arab cancer patients?

The Covid-19 pandemic has increased the vulnerability of cancer patients to psychological symptoms, in addition to treatment modality issues. The present study has aimed to determine the psychological state of Arab cancer patients during the COVID-19 pandemic and to explore the contributing factors. A cross-sectional, descriptive, correlational design with the Hospital Anxiety and Depression Scale (HADS), Insomnia Severity Index (ISI), Functional Assessment of Cancer Therapy-Fatigue subscale (FACT-F), and the Functional Assessment of Cancer Therapy-General (FACT-G) were used to collect the data. Out of 291 participants, 60.5% were female; 22.7% were 51-60 years; 31.6% were diagnosed with breast cancer; 44.3% with stage 2 cancer; 23% had contracted COVID-19; and 43.3% had received their first dose of the vaccine. The main study findings are: 74.9% had anxiety, 64.3% experienced depression, 68% suffered from insomnia, and 69.8% had fatigue. Quality of life (QoL) was low among cancer patients who had marked anxiety, depression, insomnia, or fatigue, and these findings were statistically significant (p < 0.05). Predictive factors showed males were 5.09 times more likely to report depression; gynecological cancer patients were 40.4 times more likely to experience insomnia, and patients who had COVID-19 were 5.13 times more likely to report fatigue. The study findings reveal that the COVID-19 pandemic affected the psychological state of cancer patients and had a significant effect on their quality of life. Hence, there is a need to develop a holistic cancer health care approach, which is often limited in Arab countries, to help patients manage these symptoms effectively and to decrease the prevalence of mental health morbidity.

Lung Organoids—The Ultimate Tool to Dissect Pulmonary Diseases?

Organoids are complex multicellular three-dimensional (3D) in vitro models that are designed to allow accurate studies of the molecular processes and pathologies of human organs. Organoids can be derived from a variety of cell types, such as human primary progenitor cells, pluripotent stem cells, or tumor-derived cells and can be co-cultured with immune or microbial cells to further mimic the tissue niche. Here, we focus on the development of 3D lung organoids and their use as disease models and drug screening tools. We introduce the various experimental approaches used to model complex human diseases and analyze their advantages and disadvantages. We also discuss validation of the organoids and their physiological relevance to the study of lung diseases. Furthermore, we summarize the current use of lung organoids as models of host-pathogen interactions and human lung diseases such as cystic fibrosis, chronic obstructive pulmonary disease, or SARS-CoV-2 infection. Moreover, we discuss the use of lung organoids derived from tumor cells as lung cancer models and their application in personalized cancer medicine research. Finally, we outline the future of research in the field of human induced pluripotent stem cell-derived organoids.

Plasma Endothelial and Oxidative Stress Biomarkers Associated with Late Mortality in Hospitalized COVID-19 Patients

Background: Coronavirus infectious disease 2019 (COVID-19) is a significant public health problem worldwide. COVID-19 increases the risk of non-pulmonary complications such as acute myocardial injury, renal failure, thromboembolic events, and multi-organic damage. Several studies have documented increased inflammation molecules, endothelial dysfunction biomarkers, and dysregulation of coagulation factors in COVID-19 patients. In addition, endothelium dysfunction is exacerbated by the oxidative stress (OxS) promoted by endocrine and cardiovascular molecules. Our objective was to evaluate whether endothelial and OxS biomarkers were associated with mortality in hospitalized COVID-19 patients. Methods: A prospective cohort study was performed. Patients ≥18 years old with confirmed COVID-19 that required hospitalization were included in a prospective cohort study. Endothelium and oxidative stress biomarkers were collected between 3 and 5 days after admission. Results: A total of 165 patients were evaluated; 56 patients succumbed. The median follow-up was 71 days [23–129]. Regarding endothelial dysfunction and OxS biomarkers, patients who did not survive had higher levels of nitrates (0.4564 [0.1817–0.6761] vs. 0.2817 [0.0517–0.5], p = 0.014), total nitrates (0.0507 [−0.0342–0.1809] vs. −0.0041 [−0.0887–0.0909], p = 0.016), sE-Selectin (1.095 [0.86–1.495] vs. 0.94 [0.71–1.19], p = 0.004), and malondialdehyde (MDA) (0.50 [0.26–0.72] vs. 0.36 [0.23–0.52], p = 0.010) compared to patients who survived. Endothelial and OxS biomarkers independently associated with mortality were sE-selectin (HR:2.54, CI95%; from 1.11 to 5.81, p = 0.027), nitrates (HR:4.92, CI95%; from 1.23 to 19.63, p = 0.024), and MDA (HR: 3.05, CI95%; from 1.14 to 8.15, p = 0.025). Conclusions: Endothelial dysfunction (sE-selectin and nitrates) and OxS (MDA) are independent indicators of a worse prognosis in COVID-19 patients requiring hospitalization.

The IL-1β, IL-6, and TNF cytokine triad is associated with post-acute sequelae of COVID-19

Post-acute sequelae of COVID-19 (PASC) is emerging as global problem with unknown molecular drivers. Using a digital epidemiology approach, we recruited 8,077 individuals to the cohort study for digital health research in Germany (DigiHero) to respond to a basic questionnaire followed by a PASC-focused survey and blood sampling. We report the first 318 participants, the majority thereof after mild infections. Of those, 67.8% report PASC, predominantly consisting of fatigue, dyspnea, and concentration deficit, which persists in 60% over the mean 8-month follow-up period and resolves independently of post-infection vaccination. PASC is not associated with autoantibodies, but with elevated IL-1β, IL-6, and TNF plasma levels, which we confirm in a validation cohort with 333 additional participants and a longer time from infection of 10 months. Blood profiling and single-cell data from early infection suggest the induction of these cytokines in COVID-19 lung pro-inflammatory macrophages creating a self-sustaining feedback loop.

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We report a post-COVID-19 digital epidemiology study with biomarker analysis (n = 651)

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PASC persists in 60% of participants up to 24 months after mild COVID-19

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PASC is associated with high IL-1β, IL-6, and TNF levels but not autoantibodies

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Overactivated monocytes/macrophages are likely the source of cytokine production

SARS-CoV-2: A Master of Immune Evasion

Viruses and their hosts have coevolved for a long time. This coevolution places both the pathogen and the human immune system under selective pressure; on the one hand, the immune system has evolved to combat viruses and virally infected cells, while viruses have developed sophisticated mechanisms to escape recognition and destruction by the immune system. SARS-CoV-2, the pathogen that is causing the current COVID-19 pandemic, has shown a remarkable ability to escape antibody neutralization, putting vaccine efficacy at risk. One of the virus’s immune evasion strategies is mitochondrial sabotage: by causing reactive oxygen species (ROS) production, mitochondrial physiology is impaired, and the interferon antiviral response is suppressed. Seminal studies have identified an intra-cytoplasmatic pathway for viral infection, which occurs through the construction of tunneling nanotubes (TNTs), hence enhancing infection and avoiding immune surveillance. Another method of evading immune monitoring is the disruption of the antigen presentation. In this scenario, SARS-CoV-2 infection reduces MHC-I molecule expression: SARS-CoV-2’s open reading frames (ORF 6 and ORF 8) produce viral proteins that specifically downregulate MHC-I molecules. All of these strategies are also exploited by other viruses to elude immune detection and should be studied in depth to improve the effectiveness of future antiviral treatments. Compared to the Wuhan strain or the Delta variant, Omicron has developed mutations that have impaired its ability to generate syncytia, thus reducing its pathogenicity. Conversely, other mutations have allowed it to escape antibody neutralization and preventing cellular immune recognition, making it the most contagious and evasive variant to date.

Evaluation of the Patient Experience with the Mawid App during the COVID-19 Pandemic in Al Hassa, Saudi Arabia

(1) Introduction: The objective of this study was to evaluate the patient experience with the Mawid application during the COVID-19 pandemic in Al Hassa, Saudi Arabia. (2) Methodology: A quantitative cross-sectional survey was designed to evaluate the patient experience with the Mawid app during the COVID-19 pandemic in Al Hassa, Saudi Arabia. A total of 146 respondents completed the questionnaire. (3) Results: More than half of the participants (65.8%) opined that application was easy to use. Furthermore, 65.1% of the participants considered it to be very easy and easy to search for the required information; and 63.7% of the respondents reflected that it was easy to book an appointment. There was a statistically significant difference between the ease of searching for the required information (p-value = 0.006); the ease of undoing an unwanted move and gender (p-value = 0.049); the ease of searching for the required information and educational level (p-value = 0.048); the ease of booking an appointment and educational level (p = 0.049); and the ease of searching for the required information and the labor sector of the respondents (p value= 0.049) among the genders. No significant differences were identified among the age groups. (4) Conclusions: Overall, most participants suggested that the Mawid app was easy to use and had a potentially useful set of features to help mitigate and manage the COVID-19 pandemic in Al Hassa, Saudi Arabia.

Elevated Vulnerability of Chronic Leukemia Patients to COVID-19 Infection: A Systems Biology Approach

Background

Emerging evidence has shown that SARS-CoV-2 may affect the circulatory system in addition to the human respiratory system. However, no study has indicated whether patients with leukemia have a greater likelihood of SARS-CoV-2 infection or have poor treatment outcomes.

Objective

The study aimed to demonstrate the relationship between essential blood proteins and the major SARS-CoV-2 proteins by network pharmacology bioinformatics analysis.

Methods

Bioinformatics analysis was used to establish eight differentially expressed gene hubs in leukemia through differential gene screening, protein–protein interaction network analysis, and gene enrichment analysis. Molecular docking analysis was also conducted to dock the two up-regulated proteins with the spike glycoprotein in leukemia and the critical protease enzyme (Mpro) of SARS-CoV-2.

Results

We identified two up-regulated genes (PTPRC and BCL6) among the eight differentially expressed genes. The PTPRC and BCL6 also docked perfectly with the main SARS-CoV-2 structural proteins.

Conclusion and Recommendation

This study indicates that SARS-CoV-2 is likely to affect with the blood in patients with chronic leukemia. Therefore, patients with chronic leukemia require greater medical attention and precautions during the COVID-19 pandemic.