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Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is characterized by prolonged, postacute sequelae of COVID-19 (PASC). Marked by persistent or new-onset symptoms within 3 months following COVID-19 recovery, PASC significantly affects a diverse spectrum of survivors. Beyond cardiovascular implications, neuropsychiatric PASC demonstrates prolonged symptoms with diverse phenotypic profiles affecting memory, attention, and mood. The pathophysiologic basis points to SARS-CoV-2’s neurotropism, instigating inflammatory responses in the central nervous system. A comprehensive multimodal assessment, integrating psychological evaluations, fluid examinations, neurophysiology, and imaging, emerges as a critical diagnostic approach. Managing neuropsychiatric PASC necessitates personalized interventions to enhance resilience and coping mechanisms, emphasizing the role of physical fitness, creative engagement, and social support in mitigating its impact on identity and well-being. In addition, early initiation of cognitive rehabilitation and cognitive behavioral therapy is proposed to address symptom chronicity, emotional distress, and cognitive dysfunction, enhancing the quality of life. The urgency for targeted interventions, early neuropsychological support, and ongoing research to comprehensively address the multifaceted neuropsychiatric effects of COVID-19 is underscored in this review. Collaborative efforts involving health-care professionals, support networks, and affected individuals are imperative to navigate the evolving landscape of PASC and its persistent neuropsychiatric implications.

Background and Aim: Although reverse zoonotic transmission events from humans to domestic cats have been described, there is currently little evidence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) circulation in stray cats. Due to the evidence of natural and experimental infections in cats and the capacity to disseminate the virus among them, this study aimed to identify the SARS-CoV-2 antigen in stray cats from the Federal University of Sergipe in Brazil. Materials and Methods: One hundred twenty six stray cats from the university were screened for SARS-CoV-2 antigens by random sampling. Throat swab samples were tested for the virus using rapid antigen detection tests. Results: Of the 126 animals tested, 30 (23.60%) were positive for SARS-CoV-2 antigens. To our knowledge, for the first time, this study detected the SARS-CoV-2 antigen in stray cats and confirmed the presence of SARS-CoV-2 infections in Brazil’s stray cat population. Conclusion: The detection of SARS-CoV-2 in stray cats poses a risk for infected and healthy animals and possibly for humans who attend the university daily. As a limitation of the study, the small sample size necessitates caution when interpreting the results. This underscores the need for further research in this area to help control diseases in stray animals during potential pandemics. This highlights the need for monitoring and controlling the spread of the virus in stray animal populations.

The global impact of Severe Acute Respiratory Syndrome Coronavirus-2 (SARSCOV2) is profound, with Coronavirus Disease 2019 (COVID-19) presenting a clinical spectrum that leads to multi-systemic failure, particularly affecting the pancreas and resulting in diabetes and cardiovascular co-morbidities. Diabetes, the more life-threatening manifestation of COVID-19, is associated with a 30% higher fatality rate. This review aims to explore the intricate relationship between Hyperglycaemia and hyper inflammation in individuals with post-COVID diabetes, emphasizing the risks of recurring hyperglycaemia and distinguishing it from conventional diabetes. Methodologically, data synthesis and extraction were conducted based on diabetes mellitus and recent studies on the impact of coronavirus, especially SARS, on the pancreas, utilizing articles from the Pubmed search engine. Hospitalized COVID-19 patients show a higher likelihood of concurrent conditions, including diabetes mellitus and cardiovascular diseases. Factors contributing to post-COVID diabetes include age, co-morbidities, pre-diabetic status, pre-existing micro-angiopathic disease burden, stress and direct links to elevated blood levels induced by cytokine storms or hyperinflammation from the diabetogenic virus. In conclusion, this study highlights the potential disruptions in glucose production and metabolism following COVID-19 infection. The recommendation is for individuals who have experienced COVID-19 to undergo rigorous glycemic screening approximately a month post-infection. The findings underscore the importance of monitoring and addressing alterations in glucose homeostasis as part of post-COVID-19 care. Further research and clinical observation are essential to enhance our understanding of the intricate relationship between COVID-19 and glycemic control. The key message emphasizes the comprehensive review of the interplay between SARS-CoV-2 infection and the heightened risk of diabetes, advocating for vigilant post-infection glycemic screening and revealing potential disruptions in glucose metabolism. [ABSTRACT FROM AUTHOR]

Background and Aim: Although reverse zoonotic transmission events from humans to domestic cats have been described, there is currently little evidence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) circulation in stray cats. Due to the evidence of natural and experimental infections in cats and the capacity to disseminate the virus among them, this study aimed to identify the SARS-CoV-2 antigen in stray cats from the Federal University of Sergipe in Brazil. Materials and Methods: One hundred twenty six stray cats from the university were screened for SARS-CoV-2 antigens by random sampling. Throat swab samples were tested for the virus using rapid antigen detection tests. Results: Of the 126 animals tested, 30 (23.60%) were positive for SARS-CoV-2 antigens. To our knowledge, for the first time, this study detected the SARS-CoV-2 antigen in stray cats and confirmed the presence of SARS-CoV-2 infections in Brazil's stray cat population. Conclusion: The detection of SARS-CoV-2 in stray cats poses a risk for infected and healthy animals and possibly for humans who attend the university daily. As a limitation of the study, the small sample size necessitates caution when interpreting the results. This underscores the need for further research in this area to help control diseases in stray animals during potential pandemics. This highlights the need for monitoring and controlling the spread of the virus in stray animal populations. [ABSTRACT FROM AUTHOR]

An enhanced lateral flow assay (LFA) is presented for rapid and highly sensitive detection of acute respiratory syndrome coronavirus-2 (SARS-CoV-2) antigens with gold nanoflowers (Au NFs) as signaling markers and gold enhancement to amplify the signal intensities. First, the effect of the morphology of gold nanomaterials on the sensitivity of LFA detection was investigated. The results showed that Au NFs prepared by the seed growth method showed a 5-fold higher detection sensitivity than gold nanoparticles (Au NPs) of the same particle size, which may benefit from the higher extinction coefficient and larger specific surface area of Au NFs. Under the optimized experimental conditions, the Au NFs-based LFA exhibited a detection limit (LOD) of 25 pg mL−1 for N protein using 135 nm Au NFs as the signaling probes. The signal was further amplified by using a gold enhancement strategy, and the LOD for the detection of N protein achieved was 5 pg mL−1. The established LFA also exhibited good repeatability and stability and showed applicability in the diagnosis of SARS-CoV-2 infection. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID‐19) has been a major public health burden. We hypothesised that circulating extracellular vesicles (cEVs), key players in health and disease, could trace the cell changes during COVID‐19 infection and recovery. Therefore, we studied the temporal trend of cEV and inflammatory marker levels in plasma samples of COVID‐19 patients that were collected within 24 h of patient admission (baseline, n = 80) and after hospital discharge at day‐90 post‐admission (n = 59). Inflammatory markers were measured by standard biochemical methods. cEVs were quantitatively and phenotypically characterized by high‐sensitivity nano flow cytometry. In patients recovered from COVID‐19 lower levels of inflammatory markers were detected. cEVs from vascular (endothelial cells) and blood (platelets, distinct immune subsets) cells were significantly reduced at day‐90 compared to admission levels, a pattern also observed for cEVs from progenitor, perivascular and epithelial cells. The best discriminatory power for COVID‐19 severity was found for inflammatory markers lactate dehydrogenase and neutrophil‐to‐lymphocyte ratio and for granulocyte/macrophage‐released CD66b+/CD68+‐cEVs. Albeit inflammatory markers were good indicators of systemic inflammatory response and discriminators of COVID‐19 remission, they do not completely reveal cell stress and organ damage states. cEVs reaching baseline pre‐infection levels at 90 days post‐infection in recovered patients discriminate parental cells affected by disease. [ABSTRACT FROM AUTHOR]

Introduction: Immunocompromised (IC) patients mount poor immune responses to vaccination. Higher-dose coronavirus disease 2019 (COVID-19) vaccines may offer increased immunogenicity. Methods: A pairwise meta-analysis of 98 studies reporting comparisons of mRNA-1273 (50 or 100 mcg/dose) and BNT162b2 (30 mcg/dose) in IC adults was performed. Outcomes were seroconversion, total and neutralizing antibody titers, and cellular immune responses. Results: mRNA-1273 was associated with a significantly higher seroconversion likelihood [relative risk, 1.11 (95% CI, 1.08, 1.14); P < 0.0001; I2 = 66.8%] and higher total antibody titers [relative increase, 50.45% (95% CI, 34.63%, 66.28%); P < 0.0001; I2 = 89.5%] versus BNT162b2. mRNA-1273 elicited higher but statistically nonsignificant relative increases in neutralizing antibody titers and cellular immune responses versus BNT162b2. Conclusion: Higher-dose mRNA-1273 had increased immunogenicity versus BNT162b2 in IC patients. [ABSTRACT FROM AUTHOR]

Objective: Previous research has shown that human identical sequences of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) promote coronavirus disease 2019 (COVID-19) progression by upregulating hyaluronic acid (HA). However, the association of HA with mortality and long COVID in SARS-CoV-2 reinfection and first infection is unclear. Methods: Patients with COVID-19 at Beijing Ditan Hospital from September 2023 to November 2023 were consecutively enrolled. SARS-CoV-2 reinfections were matched 1:2 with first infections using a nearest neighbor propensity score matching algorithm. We compared the hospital outcomes between patients with COVID-19 reinfection and first infection. The association between HA levels and mortality and long COVID in the matched cohort was analyzed. Results: The reinfection rate among COVID-19 hospitalized patients was 25.4% (62 cases). After propensity score matching, we found that reinfection was associated with a better clinical course and prognosis, including lower levels of C-reactive protein and erythrocyte sedimentation rate, fewer cases of bilateral lung infiltration and respiratory failure, and shorter viral clearance time and duration of symptoms (p < 0.05). HA levels were significantly higher in patients with primary infection [128.0 (90.5, 185.0) vs. 94.5 (62.0, 167.3), p = 0.008], those with prolonged viral clearance time [90.5 (61.5, 130.8) vs. 130.0 (95.0, 188.0), p < 0.001], and deceased patients [105.5 (76.8, 164.5) vs. 188.0 (118.0, 208.0), p = 0.002]. Further analysis showed that HA was an independent predictor of death (AUC: 0.789), and the risk of death increased by 4.435 times (OR = 5.435, 95% CI = 1.205-24.510, p = 0.028) in patients with high HA levels. We found that patients with HA levels above 116 ng/mL had an increased risk of death. However, the incidence of long COVID was similar in the different HA level groups (p > 0.05). Conclusion: Serum HA may serve as a novel biomarker for predicting COVID-19 mortality in patients with SARS-CoV-2 reinfection and first infection. However, HA levels may not be associated with long COVID. [ABSTRACT FROM AUTHOR]

COVID-19 is a spectrum of clinical symptoms in humans caused by infection with SARS-CoV-2. The coalescence of SARS-CoV-2 with seasonal respiratory viruses, particularly influenza viruses, is a global health concern. To understand this, transgenic mice expressing the human ACE2 receptor (K18-hACE2) were infected with influenza A virus (IAV) followed by SARS-CoV-2 and the host response and effect on virus biology was compared to K18-hACE2 mice infected with IAV or SARS-CoV-2 alone. The sequentially infected mice showed reduced SARS-CoV-2 RNA synthesis, yet exhibited more rapid weight loss, more severe lung damage and a prolongation of the innate response compared to the singly infected or control mice. Sequential infection also exacerbated the extrapulmonary encephalitic manifestations associated with SARS-CoV-2 infection. Conversely, prior infection with a commercially available, multivalent live-attenuated influenza vaccine (Fluenz Tetra) elicited the same reduction in SARS-CoV-2 RNA synthesis, albeit without the associated increase in disease severity. This suggests that the innate immune response stimulated by IAV inhibits SARS-CoV-2. Interestingly, infection with an attenuated, apathogenic influenza vaccine does not result in an aberrant immune response and enhanced disease severity. Taken together, the data suggest coinfection ('twinfection') is deleterious and mitigation steps should be instituted as part of the comprehensive public health and management strategy of COVID-19. [ABSTRACT FROM AUTHOR]

Abstract Background The STROMA-CoV-2 study was a French phase 2b, multicenter, double-blind, randomized, placebo-controlled clinical trial that did not identify a significant efficacy of umbilical cord-derived mesenchymal stromal cells in patients with SARS-CoV-2-induced acute respiratory distress syndrome. Safety on day 28 was found to be good. The aim of our extended study was to assess the 6- and 12-month safety of UC-MSCs administration in the STROMA-CoV-2 cohort. Methods A detailed multi-domain assessment was conducted at 6 and 12 months following hospital discharge focusing on adverse events, lung computed tomography-scan, pulmonary and muscular functional status, and quality of life in the STROMA-CoV-2 cohort including SARS–CoV-2-related early (

Background: Vulnerability to infectious diseases in refugees is dependent on country of origin, flight routes, and conditions. Information on specific medical needs of different groups of refugees is lacking. We assessed the prevalence of infectious diseases, immunity to vaccine-preventable diseases, and chronic medical conditions in children, adolescents, and adult refugees from Ukraine who arrived in Germany in 2022. Methods: Using different media, we recruited Ukrainian refugees at 13 sites between 9–12/2022. An antigen test for acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection, serologies for a range of vaccine-preventable diseases, as well as interferon gamma release assays (IGRAs) for tuberculosis (TB), and SARS-CoV-2 were performed. We assessed personal and family history of chronic medical conditions, infectious diseases, vaccination status, and conditions during migration. Results: Overall, 1793 refugees (1401 adults and 392 children/adolescents) were included. Most participants were females (n = 1307; 72·3%) and from Eastern or Southern Ukraine. TB IGRA was positive in 13% (n = 184) of the adults and in 2% (n = 7) of the children.Serology-based immunological response was insufficient in approximately 21% (360/1793) of the participants for measles, 32% (572/1793) for diphtheria, and 74% (1289/1793) for hepatitis B. Conclusions: We show evidence of low serological response to vaccine-preventable infections and increased LTBI prevalence in Ukrainian refugees. These findings should be integrated into guidelines for screening and treatment of infectious diseases in migrants and refugees in Germany and Europe. Furthermore, low immunity for vaccine-preventable diseases in Ukrainians independent of their refugee status, calls for tailor-made communication efforts.

Yue Zhang,1,&ast; Qi Li,1,&ast; Jiang-Lin Xiang,2 Xing-Hua Li,1 Jing Li3 1Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China; 2Department of Infectious Disease, Chongqing University Three Gorges Hospital, Chongqing, 404000, People’s Republic of China; 3Medical Department, Liangjiang New Area Renhe Community Health Service Center, Chongqing, 401147, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jing Li, Medical Department, Liangjiang New Area Renhe Community Health Service center, Chongqing, 401147, People’s Republic of China, Tel +86 18716469389, Email lijing_345678@163.com Xing-Hua Li, Tel +86 18584603726, Email 595904844@qq.comPurpose: To investigate potential differences in clinical and computed tomography (CT) features between patients with the SARS‐CoV‐2 Omicron variant and the original strain.Patients and Methods: This retrospective study included 69 hospitalized patients infected with Omicron variant from November to December 2022, and 96 hospitalized patients infected with the original strain from February to March 2020 in Chongqing, China. The clinical features, CT manifestations, degrees of lung involvement in different stages on CT, and imaging changes after the reverse-transcription polymerase chain reaction (RT-PCR) results turned negative were compared between the two groups.Results: For clinical features, patients with Omicron were predominantly old people and females, without manifestation of any clinical symptoms, who had low serum levels of C-reactive protein and procalcitonin. Shorter interval from symptoms onset to initial CT scan was observed in Omicron patients compared to patients with the original strain (all P < 0.05). For CT features, patients with Omicron were more likely to present with round-like opacities and tree-in-bud pattern (all P < 0.05), but less likely to exhibit a diffuse distribution, patchy and linear opacities, as well as vascular enlargement pattern (all P < 0.05). The Omicron group was more susceptible to exhibiting lower CT involvement scores in each stage (all P < 0.05) and imaging progression after the RT-PCR results turned negative (P < 0.001).Conclusion: Patients infected with the Omicron variant exhibited less severe changes on chest CT compared to those infected with the original strain. Furthermore, imaging progression under low viral load conditions was more common in patients with Omicron than in those with the original strain.Keywords: severe acute respiratory syndrome coronavirus-2, pneumonia, computed tomography

At the end of 2022, a total of 20,003 diagnoses of human immunodeficiency virus (HIV) infection and 8,983 cases of acquired immunodeficiency syndrome (AIDS) among Japanese nationals, and 3,860 HIV diagnoses and 1,575 AIDS cases among foreign residents, had been notified to the government in Japan. This study updates the estimate of HIV incidence, including during the COVID-19 pandemic. It aimed to reconstruct the incidence of HIV and understand how the disruption caused by COVID-19 affected the epidemiology of HIV. Using a median incubation period of 10.0 years, the number of undiagnosed HIV infections was estimated to be 3,209 (95% confidence interval (CI): 2,642, 3,710) at the end of 2022. This figure has declined steadily over the past 10 years. Assuming that the median incubation period was 10.0 years, the proportion of diagnosed HIV infections, including surviving AIDS cases, was 89.3% (95% CI: 87.8%, 91.0%). When AIDS cases were excluded, the proportion was 86.2% (95% CI: 84.3%, 88.3%). During the COVID-19 pandemic, the estimated annual diagnosis rate was slightly lower than during earlier time intervals, at around 16.5% (95% CI: 14.9%, 18.1%). Japan may already have achieved diagnostic coverage of 90%, given its 9% increment in the diagnosed proportion during the past 5 years. The incidence of HIV infection continued to decrease even during the COVID-19 pandemic from 2020 to 2022, and the annual rate of diagnosis decreased slightly to 16.5%. Monitoring the recovery of diagnosis along with the effective reproduction number is vital in the future.

Genetic analysis of intra-host viral populations provides unique insight into pre-emergent mutations that may contribute to the genotype of future variants. Clinical samples positive for SARS-CoV-2 collected in California during the first months of the pandemic were sequenced to define the dynamics of mutation emergence as the virus became established in the state. Deep sequencing of 90 nasopharyngeal samples showed that many mutations associated with the establishment of SARS-CoV-2 globally were present at varying frequencies in a majority of the samples, even those collected as the virus was first detected in the US. A subset of mutations that emerged months later in consensus sequences were detected as subconsensus members of intra-host populations. Spike mutations P681H, H655Y, and V1104L were detected prior to emergence in variant genotypes, mutations were detected at multiple positions within the furin cleavage site, and pre-emergent mutations were identified in the nucleocapsid and the envelope genes. Because many of the samples had a very high depth of coverage, a bioinformatics pipeline, "Mappgene", was established that uses both iVar and LoFreq variant calling to enable identification of very low-frequency variants. This enabled detection of a spike protein deletion present in many samples at low frequency and associated with a variant of concern.

The COVID-19 pandemic highlighted public awareness of airborne disease transmission in indoor settings and emphasized the need for reliable air disinfection technologies. This increased awareness will carry in the post-pandemic era along with the ever-emerging SARS-CoV variants, necessitating effective and well-defined protocols, methods, and devices for air disinfection. Ultraviolet (UV)-based air disinfection demonstrated promising results in inactivating viral bioaerosols. However, the reported data diversity on the required UVC doses has hindered determining the best UVC practices and led to confusion among the public and regulators. This article reviews available information on critical parameters influencing the efficacy of a UVC air disinfection system and, consequently, the required dose including the systems components as well as operational and environmental factors. There is a consensus in the literature that the interrelation of humidity and air temperature has a significant impact on the UVC susceptibility, which translate to changing the UVC efficacy of commercialized devices in indoor settings under varying conditions. Sampling and aerosolization techniques reported to have major influence on the result interpretation and it is recommended to use several sampling methods simultaneously to generate comparable and conclusive data. We also considered the safety concerns and the potential safe alternative of UVC, far-UVC. Finally, the gaps in each critical parameter and the future research needs of the field are represented. This paper is the first step to consolidating literature towards developing a standard validation protocol for UVC air disinfection devices which is determined as the one of the research needs.

Vulnerability to infectious diseases in refugees is dependent on country of origin, flight routes, and conditions. Information on specific medical needs of different groups of refugees is lacking. We assessed the prevalence of infectious diseases, immunity to vaccine-preventable diseases, and chronic medical conditions in children, adolescents, and adult refugees from Ukraine who arrived in Germany in 2022. Using different media, we recruited Ukrainian refugees at 13 sites between 9–12/2022. An antigen test for acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection, serologies for a range of vaccine-preventable diseases, as well as interferon gamma release assays (IGRAs) for tuberculosis (TB), and SARS-CoV-2 were performed. We assessed personal and family history of chronic medical conditions, infectious diseases, vaccination status, and conditions during migration. Overall, 1793 refugees (1401 adults and 392 children/adolescents) were included. Most participants were females (n = 1307; 72·3%) and from Eastern or Southern Ukraine. TB IGRA was positive in 13% (n = 184) of the adults and in 2% (n = 7) of the children. Serology-based immunological response was insufficient in approximately 21% (360/1793) of the participants for measles, 32% (572/1793) for diphtheria, and 74% (1289/1793) for hepatitis B. We show evidence of low serological response to vaccine-preventable infections and increased LTBI prevalence in Ukrainian refugees. These findings should be integrated into guidelines for screening and treatment of infectious diseases in migrants and refugees in Germany and Europe. Furthermore, low immunity for vaccine-preventable diseases in Ukrainians independent of their refugee status, calls for tailor-made communication efforts. [ABSTRACT FROM AUTHOR]

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Abstract Coronavirus disease 2019 (COVID‐19) has been a major public health burden. We hypothesised that circulating extracellular vesicles (cEVs), key players in health and disease, could trace the cell changes during COVID‐19 infection and recovery. Therefore, we studied the temporal trend of cEV and inflammatory marker levels in plasma samples of COVID‐19 patients that were collected within 24 h of patient admission (baseline, n = 80) and after hospital discharge at day‐90 post‐admission (n = 59). Inflammatory markers were measured by standard biochemical methods. cEVs were quantitatively and phenotypically characterized by high‐sensitivity nano flow cytometry. In patients recovered from COVID‐19 lower levels of inflammatory markers were detected. cEVs from vascular (endothelial cells) and blood (platelets, distinct immune subsets) cells were significantly reduced at day‐90 compared to admission levels, a pattern also observed for cEVs from progenitor, perivascular and epithelial cells. The best discriminatory power for COVID‐19 severity was found for inflammatory markers lactate dehydrogenase and neutrophil‐to‐lymphocyte ratio and for granulocyte/macrophage‐released CD66b+/CD68+‐cEVs. Albeit inflammatory markers were good indicators of systemic inflammatory response and discriminators of COVID‐19 remission, they do not completely reveal cell stress and organ damage states. cEVs reaching baseline pre‐infection levels at 90 days post‐infection in recovered patients discriminate parental cells affected by disease.

Introduction: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a novel coronavirus (nCoV) that causes viral pneumonia known as Coronavirus Disease 2019 (COVID-19). It can infect people of all age groups, and various clinical conditions are strong indicators of co-morbidities in COVID-19. The presence of co-morbidities is crucial in determining the clinical outcome of coronavirus infections. Therefore, it is crucial to understand the demographic profile and associated risk factors of COVID-19 in this geographical region. Aim: To assess the association between SARS-CoV-2 infection and demographic characteristics and co-morbidities. Materials and Methods: A retrospective cohort study was conducted at the National Accreditation Board for Testing and Calibration Laboratories (NABL)-accredited Virology Service Laboratory (VSL) of Tripura Medical College and Dr. BR Ambedkar Memorial Teaching Hospital, Agartala, Tripura, India. All the required data was collected between May 2021 and October 2022, and data analysis was carried out from February to March 2023. After obtaining Indian Council of Medical Research (ICMR) approval, real-time Reverse Transcriptase-Polymerase Chain Reaction (rRT-PCR) was used for the detection of SARS-CoV-2 RNA. A total of 10,263 samples were included in the study. RNA extraction was performed using the viral Ribonucleic Acid (RNA) extraction Miniprep Kit protocol manufactured by MDI Membrane Technologies, and RT-PCR was conducted according to the Indian Council of Medical Research (ICMR)-approved DiAGSureTM nCoV-19 Detection Assay (Multiplex, TaqMan based) protocol developed by GCC BIOTECH. The findings were based on demographic parameters such as age group and gender distribution. Results were expressed as proportions and percentages, and statistical analysis was done by Chi-square test in Statistical Package for Social Sciences (SPSS) version 20.0. Results: Out of the 10,263 registered patients, 1471 (14.33%) were confirmed to have SARS-CoV-2 infection. The most affected age group was found to be between 21 and 40 years, with 524 (35.62%) cases. Males, 927 (63.02%) were more frequently infected than females, 544 (36.98%). Among all the SARS-CoV-2 infected patients, co-morbidities were found in 254 (17.26%) cases, and the association between co-morbidities and the rRT-PCR test results was found to be statistically significant, with a p-value=0.01. Conclusion: The highest number of SARS-CoV-2 patients were found in the age group of 21 to 40 years, predominantly among males. Patients with co-morbidities showed a significant association with SARS-CoV-2 infection. Diabetes was found to be the most prevalent risk factor among all the patients.

Context: Evidence shows that knowledge is important in tackling pandemics. By assessing awareness and knowledge about the coronavirus, more profound insights can be gained into existing public reception and practices, thereby helping to identify attributes that influence the adoption of healthy practices and responsive behavior. Assessing knowledge is important in identifying gaps and strengthening ongoing prevention efforts. Aims: The study aimed to investigate the geriatric population's knowledge, attitudes, and practices (KAP) toward coronavirus disease-2019 (COVID-19) during the pandemic spike. Settings and Design: The study was designed as a cross-sectional study; a questionnaire was developed regarding the World Health Organization training material for the detection, prevention, response, and control of COVID-19 and was validated by experts in geriatrics and public health. Materials and Methods: A prevalidated questionnaire consisting of four sections will be used. The first section consists of demographic data such as age and gender. The second, third, and fourth section will include prevalidated questions to gather information about the patient's KAP regarding general awareness of COVID-19 among geriatric patients in a tertiary care center in central Kerala. The inclusion criteria included patients of age 60 years and above, patients who are willing to participate in the study, and patients who are willing to give informed consent. The questionnaire was answered by over 199 participants anonymously from November 01, 2021, to February 08, 2022. Results: In our study, 199 participants were involved the mean knowledge score was 10.3 ± 1.224. The average attitude score regarding COVID-19 among the participants was 1.9 ± 1.1. The majority of the participants (67.8%) had a poor attitude toward COVID-19. There was a significant difference in average attitude scores according to socioeconomic status. According to the present study, the average correct answer score of the ten questions regarding COVID-19 practice was 6.3 ± 1.4. The majority of participants (75.4%) had moderate practice toward COVID-19. The average practice scores were significant difference among the socioeconomic status. Conclusions: The third wave of the pandemic demonstrated good knowledge, positive attitudes, and reasonable practice regarding COVID-19 during the outbreak. The results indicated the need for the health system to attempt to increase the public knowledge of the older people to improve their attitude and practice to deal with the crisis.

Fumihiro Yamaguchi,1 Ayako Suzuki,2 Miyuki Hashiguchi,3 Emiko Kondo,3 Atsuo Maeda,4 Takuya Yokoe,1 Jun Sasaki,4 Yusuke Shikama,1 Munetaka Hayashi,4 Sei Kobayashi,5 Hiroshi Suzuki6 1Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan; 2Department of Pharmacy, Showa University Fujigaoka Hospital, Yokohama, Japan; 3Department of Infection Control, Showa University Fujigaoka Hospital, Yokohama, Japan; 4Department of Emergency and Critical Care Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan; 5Department of Otolaryngology, Showa University Fujigaoka Hospital, Yokohama, Japan; 6Department of Cardiology, Showa University Fujigaoka Hospital, Yokohama, JapanCorrespondence: Fumihiro Yamaguchi, Department of Respiratory Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, 227-8501, Japan, Email f_y@med.showa-u.ac.jpBackground: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), immediately became a pandemic. Therefore, nosocomial infection control is necessary to screen for patients with possible COVID-19.Objective: This study aimed to investigate commonly measured clinical variables to predict COVID-19.Methods: This cross-sectional study enrolled 1087 patients in the isolation ward of a university hospital. Conferences were organized to differentiate COVID-19 from non-COVID-19 cases, and multiple nucleic acid tests were mandatory when COVID-19 could not be excluded. Multivariate logistic regression models were employed to determine the clinical factors associated with COVID-19 at the time of hospitalization.Results: Overall, 352 (32.4%) patients were diagnosed with COVID-19. The majority of the non-COVID-19 cases were predominantly caused by bacterial infections. Multivariate analysis indicated that COVID-19 was significantly associated with age, sex, body mass index, lactate dehydrogenase, C-reactive protein, and malignancy.Conclusion: Some clinical factors are useful to predict patients with COVID-19 among those with symptoms similar to COVID-19. This study suggests that at least two real-time reverse-transcription polymerase chain reactions of SARS-CoV-2 are recommended to exclude COVID-19.Keywords: severe acute respiratory syndrome coronavirus-2, coronavirus disease 2019, nosocomial infection control, nucleic acid test, obesity, cross sectional study, Japan

Abstract Background In this study, we report a case series of acute macular neuroretinopathy (AMN) associated with COVID-19 infection. Methods This retrospective observational study was conducted at Beijing Tongren Hospital. We reviewed patients who were diagnosed with AMN within one month of testing positive for COVID-19 using real-time reverse transcription-polymerase chain reaction (RT-PCR). Results A total of 11 AMN patients (20 eyes) were included in the study. The mean age was 33.8 ± 12.6 years. The average interval between a positive COVID-19 PCR test and the onset of ocular symptoms was 2.8 ± 2.5 days. The mean follow-up period for the patients was 12.5 ± 3.8 weeks. Imaging characteristics of AMN patients following COVID-19 infection included areas of low reflectivity on near-infrared reflectance (NIR) imaging, hyperreflective lesions at the level of the outer plexiform layer (OPL) and outer nuclear layer (ONL) and disruption of the ellipsoid zone (EZ) on spectral domain optical coherence tomography (SD-OCT) B-scans. Visual field examinations revealed parafoveal scotomas that closely corresponded to the clinical lesions. Optical coherence tomography angiography (OCT-A) demonstrated impaired perfusion in the deep retinal vascular plexus. Fluorescein angiography (FA), indocyanine green angiography (ICGA), and spontaneous fundus autofluorescence showed no significant abnormalities. During follow-up, partial improvement in retinal lesions was observed in NIR imaging and SD-OCT in some patients, but a proportion of patients still exhibited persistent retinal damage and no improvement in visual field scotomas. Conclusion COVID-19-related AMN share similar clinical and imaging features with AMN due to other causes, as evidenced by the persistent presence of visual field scotomas over a longer duration. Trail registration https://www.chictr.org.cn/ ; identifier: ChiCTR2100044365

Introduction: Coronavirus Disease-2019 (COVID-19) is an ongoing global pandemic. Changes in haematological variables in patients with COVID-19 are emerging as important features of the disease. These changes in haematological variables may provide significant clues in the prognosis post Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection. Aim: To determine the significance of various haematological variables in cardiac outcomes post SARS-CoV-2 infection. Materials and Methods: This was a prospective cohort study conducted at Prince Faisal bin Khalid Cardiac Centre, Abha, Kingdom of Saudi between March 2021 and October 2021. A total of 59 patients who were infected with SARS-CoV-2 with or without cardiac complaints were involved. Demographic, clinical, and laboratory data were recorded. Leukocyte counts, Neutrophil Counts, Lymphocyte counts, Neutrophil to Lymphocyte Ratio (NLR), platelet counts, Prothrombin Time (PT), Activated Partial Thromboplastin Time (APTT), and D-Dimer were assessed and compared between subjects who developed Cardiovascular Complications (CVC+ group) and the subjects who did not develop CVC post SARS-CoV-2 infection (CVCgroup). Statistical analyses were performed using R scripting language and R Studio (version 1.2.5033, Orange Blossom). For continuous variables, t-test (for normally distributed) and MannWitney U test (for non normally distributed) were employed. For categorical data, Chi-square test (c2 ) was used. A p-value

The waves of the Coronavirus Disease 2019 (COVID-19) pandemic have disrupted healthcare systems globally, with a staggering number of confirmed cases reaching 593 million and a death toll of six million. While the primary target organ of COVID-19 is the lungs, the novel coronavirus, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) also shows a preference for the intestinal epithelium, which expresses Angiotensin Converting Enzyme 2 (ACE2), a receptor necessary for viral entry into host cells. The composition and abundance of beneficial gut microbiota play a critical role in protecting against severe disease and complications, whereas dysbiosis contribute to systemic inflammation and immune imbalances during SARS-CoV-2 infection. Recent insights into the microbiome have emphasised the importance of the gut-lung axis and the microenvironments of the gut and lungs in the context of COVID-19. These findings offer opportunities for the development of new diagnostic and therapeutic strategies. In this review, the significance of the gut-lung axis, as well as the intestinal and pulmonary microbiota, in COVID-19, were explored with a particular focus on their potential applications.

BackgroundIn COVACTA, a randomised, placebo-controlled trial in patients hospitalised with coronavirus disease-19 (COVID-19), tocilizumab did not improve 28-day mortality, but shortened hospital and intensive care unit stay. Longer-term effects of tocilizumab in patients with COVID-19 are unknown. Therefore, the efficacy and safety of tocilizumab in COVID-19 beyond day 28 and its impact on Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) clearance and antibody response in COVACTA were investigated.MethodsAdults in Europe and North America hospitalised with COVID-19 (N = 452) between April 3, 2020 and May 28, 2020 were randomly assigned (2:1) to double-blind intravenous tocilizumab or placebo and assessed for efficacy and safety through day 60. Assessments included mortality, time to hospital discharge, SARS-CoV-2 viral load in nasopharyngeal swab and serum samples, and neutralising anti-SARS-CoV-2 antibodies in serum. ClinicalTrials.gov registration: NCT04320615.FindingsBy day 60, 24·5% (72/294) of patients in the tocilizumab arm and 25·0% (36/144) in the placebo arm died (weighted difference -0·5% [95% CI -9·1 to 8·0]), and 67·0% (197/294) in the tocilizumab arm and 63·9% (92/144) in the placebo arm were discharged from the hospital. Serious infections occurred in 24·1% (71/295) of patients in the tocilizumab arm and 29·4% (42/143) in the placebo arm. Median time to negative reverse transcriptase-quantitative polymerase chain reaction result in nasopharyngeal/oropharyngeal samples was 15·0 days (95% CI 14·0 to 21·0) in the tocilizumab arm and 21·0 days (95% CI 14·0 to 28·0) in the placebo arm. All tested patients had positive test results for neutralising anti-SARS-CoV-2 antibodies at day 60.InterpretationThere was no mortality benefit with tocilizumab through day 60. Tocilizumab did not impair viral clearance or host immune response, and no new safety signals were observed. Future investigations may explore potential biomarkers to optimize patient selection for tocilizumab treatment and combination therapy with other treatments.FundingF. Hoffmann-La Roche Ltd and the US Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, Biomedical Advanced Research and Development Authority, under OT number HHSO100201800036C.

Background: In this study, we report a case series of acute macular neuroretinopathy (AMN) associated with COVID-19 infection. Methods: This retrospective observational study was conducted at Beijing Tongren Hospital. We reviewed patients who were diagnosed with AMN within one month of testing positive for COVID-19 using real-time reverse transcription-polymerase chain reaction (RT-PCR). Results: A total of 11 AMN patients (20 eyes) were included in the study. The mean age was 33.8 ± 12.6 years. The average interval between a positive COVID-19 PCR test and the onset of ocular symptoms was 2.8 ± 2.5 days. The mean follow-up period for the patients was 12.5 ± 3.8 weeks. Imaging characteristics of AMN patients following COVID-19 infection included areas of low reflectivity on near-infrared reflectance (NIR) imaging, hyperreflective lesions at the level of the outer plexiform layer (OPL) and outer nuclear layer (ONL) and disruption of the ellipsoid zone (EZ) on spectral domain optical coherence tomography (SD-OCT) B-scans. Visual field examinations revealed parafoveal scotomas that closely corresponded to the clinical lesions. Optical coherence tomography angiography (OCT-A) demonstrated impaired perfusion in the deep retinal vascular plexus. Fluorescein angiography (FA), indocyanine green angiography (ICGA), and spontaneous fundus autofluorescence showed no significant abnormalities. During follow-up, partial improvement in retinal lesions was observed in NIR imaging and SD-OCT in some patients, but a proportion of patients still exhibited persistent retinal damage and no improvement in visual field scotomas. Conclusion: COVID-19-related AMN share similar clinical and imaging features with AMN due to other causes, as evidenced by the persistent presence of visual field scotomas over a longer duration. Trail registration: https://www.chictr.org.cn/; identifier: ChiCTR2100044365 [ABSTRACT FROM AUTHOR]

Background: Inflammatory bowel disease (IBD) including Crohn’s disease (CD) and ulcerative colitis (UC), are associated with higher thrombotic risk and enhanced thrombin generation (TG) in adults. Despite encouraging data reporting vaccine safety and low IBD flare rates in adults with IBD, vaccine hesitancy was demonstrated to be high in families of children with IBD. We aimed to find out whether TG is increased in children with IBD as compared to healthy controls and whether TG parameters show significant changes following SARSCoV-2 mRNA vaccination. Patients and methods: In this observational case-control study, 38 children with IBD (CD:18, UC: 20) aged 12-18 years and 62 healthy age-and sex-matched children were enrolled. Blood was collected before the first dose and 2-6 weeks after the second dose of BNT162b2 (Pfizer-BioNTech) mRNA vaccine dose. Blood cell counts, fibrinogen, inflammatory markers (hsCRP, ferritin), anti-SARSCoV-2 antibody levels were investigated, TG assay was carried-out using platelet-poor plasma. Detailed clinical parameters including disease activity scores (PUCAI, PCDAI) were registered pre-and post- vaccination. A guided questionnaire was used to collect data on adverse reactions (AEs) postvaccination. Results: Baseline TG parameters did not differ between patients and controls. Endogenous thrombin potential showed a significant positive correlation with markers of inflammation and with PCDAI. Inflammatory parameters and TG did not increase in patients and controls post-vaccination. Vaccination significantly increased antibody levels in all three investigated groups, but post-vaccination anti-SARS-CoV-2 S IgG/IgM levels were below the 5th percentile value of healthy children in more than one third of patients. Those receiving TNFa inhibitor therapy presented significantly lower SARS-CoV-2 S IgG/IgM levels as compared to patients on other immunosuppressive regimens. Systemic AEs did not differ between patients and controls while lower rate of local symptoms was found post-vaccination in children with IBD. Only 2 IBD flares were detected 2-6 weeks after the second dose of vaccination. Conclusion: Our study is the first to support the safety and efficacy of anti-SARSCoV-2 BNT162b2 vaccination in children with IBD with detailed pre-and postvaccination laboratory data including TG. Results of this study may further increase confidence and reduce vaccine hesitancy in caretakers of pediatric IBD patients. [ABSTRACT FROM AUTHOR]

The waves of the Coronavirus Disease 2019 (COVID-19) pandemic have disrupted healthcare systems globally, with a staggering number of confirmed cases reaching 593 million and a death toll of six million. While the primary target organ of COVID-19 is the lungs, the novel coronavirus, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) also shows a preference for the intestinal epithelium, which expresses Angiotensin Converting Enzyme 2 (ACE2), a receptor necessary for viral entry into host cells. The composition and abundance of beneficial gut microbiota play a critical role in protecting against severe disease and complications, whereas dysbiosis contribute to systemic inflammation and immune imbalances during SARS-CoV-2 infection. Recent insights into the microbiome have emphasised the importance of the gut-lung axis and the microenvironments of the gut and lungs in the context of COVID-19. These findings offer opportunities for the development of new diagnostic and therapeutic strategies. In this review, the significance of the gut-lung axis, as well as the intestinal and pulmonary microbiota, in COVID-19, were explored with a particular focus on their potential applications. [ABSTRACT FROM AUTHOR]

ObjectiveHuman identical sequences of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) promoted the coronavirus disease 2019 (COVID-19) progression by upregulating hyaluronic acid (HA) via NamiRNA-enhancer network, based on previous experimental research. This study aimed to investigate the predictive value of HA for the severity of SARS-CoV-2 infection in the post-COVID-19 era.MethodsA total of 217 consecutive patients with COVID-19 were enrolled at Beijing Ditan Hospital between July 2023 and October 2023. HA levels were analyzed using biochemical detector. Logistic regression analysis was used to screen independent factors for severe COVID-19. The predictive performance of HA for severe infection was assessed by ROC curve. Furthermore, the relationship between HA levels and COVID-19 severity was investigated using multivariate logistic regression models after adjustment for potential confounders.ResultsAccording to the cut-off value of HA, COVID-19 patients were divided into HA < 90 ng/mL group (80 cases) and HA ≥ 90 ng/mL group (137 cases). High HA levels were positively associated with the severe SARS-CoV-2 infection, including elevated inflammatory indicators, severe lung involvement, prolonged clinical course, and higher incidence of respiratory failure and death (P < 0.05). Logistic regression analysis suggested that HA was an independent predictor of severe COVID-19 (OR = 4.540, 95% CI = 2.105-9.790, P < 0.001). ROC curve analysis showed that the AUC of HA for severe infection was 0.724. HA levels were significantly higher in COVID-19 cases compared to the healthy population (123.9 (82.6, 174.1) vs. 50.5 (37.8, 66.8), P < 0.001), but similar to those with non-SARS-CoV-2 lung infection (121.6 (78.5, 175.6) vs. 106.0 (66.5, 149.7), P = 0.244). We also found that the first COVID-19 infections had higher HA levels (118.8 (79.5, 174.3) vs. 85.0 (61.1, 128.8), P < 0.001) and a higher proportion of severe infection (37.1% vs. 21.3%, P = 0.043) than re-infections. However, HA expression failed to fully return to normal levels with infection recovery (204.7 (152.9, 242.2) vs. 97.0 (69.3, 137.3), P < 0.001).ConclusionHA was associated with severe SARS-CoV-2 infection and could be used as a novel serum biomarker to predict the risk of COVID-19 progression in the post-COVID-19 era.

This review was focused on global data analysis and risk factors associated with morbidity and mortality of coronavirus disease 2019 from different countries, including Bangladesh, Brazil, China, Central Eastern Europe, Egypt, India, Iran, Pakistan, and South Asia, Africa, Turkey and UAE. Male showed higher confirmed and death cases compared to females in most of the countries. In addition, the case fatality ratio (CFR) for males was higher than for females. This gender variation in COVID-19 cases may be due to males cultural activities, but similar variations in the number of COVID-19 affected males and females globally. Variations in the immune system can illustrate this divergent risk comparatively higher in males than females. The female immune system may have an edge to detect pathogens slightly earlier. In addition, women show comparatively higher innate and adaptive immune responses than men, which might be explained by the high density of immune-related genes in the X chromosome. Furthermore, SARS-CoV-2 viruses use angiotensin-converting enzyme 2 (ACE2) to enter the host cell, and men contain higher ACE2 than females. Therefore, males may be more vulnerable to COVID-19 than females. In addition, smoking habit also makes men susceptible to COVID-19. Considering the age-wise distribution, children and older adults were less infected than other age groups and the death rate. On the contrary, more death in the older group may be associated with less immune system function. In addition, most of these group have comorbidities like diabetes, high pressure, low lungs and kidney function, and other chronic diseases. Due to the substantial economic losses and the numerous infected people and deaths, research examining the features of the COVID-19 epidemic is essential to gain insight into mitigating its impact in the future and preparedness for any future epidemics.

ObjectivesTo describe hospital variation in use of "guideline-based care" for acute respiratory distress syndrome (ARDS) due to COVID-19.DesignRetrospective, observational study.SettingThe Society of Critical Care Medicine's Discovery Viral Infection and RESPIRATORY ILLNESS UNIVERSAL STUDY COVID-19 REGISTRY.PatientsAdult patients with ARDS due to COVID-19 between February 15, 2020, and April 12, 2021.InterventionsHospital-level use of "guideline-based care" for ARDS including low-tidal-volume ventilation, plateau pressure less than 30 cm H2O, and prone ventilation for a Pao2/Fio2 ratio less than 100.Measurements and main resultsAmong 1,495 adults with COVID-19 ARDS receiving care across 42 hospitals, 50.4% ever received care consistent with ARDS clinical practice guidelines. After adjusting for patient demographics and severity of illness, hospital characteristics, and pandemic timing, hospital of admission contributed to 14% of the risk-adjusted variation in "guideline-based care." A patient treated at a randomly selected hospital with higher use of guideline-based care had a median odds ratio of 2.0 (95% CI, 1.1-3.4) for receipt of "guideline-based care" compared with a patient receiving treatment at a randomly selected hospital with low use of recommended therapies. Median-adjusted inhospital mortality was 53% (interquartile range, 47-62%), with a nonsignificantly decreased risk of mortality for patients admitted to hospitals in the highest use "guideline-based care" quartile (49%) compared with the lowest use quartile (60%) (odds ratio, 0.7; 95% CI, 0.3-1.9; p = 0.49).ConclusionsDuring the first year of the COVID-19 pandemic, only half of patients received "guideline-based care" for ARDS management, with wide practice variation across hospitals. Strategies that improve adherence to recommended ARDS management strategies are needed.

Qi Li,1 Yongli Wang,2,&ast; Huawen Liu,3 Hailang Peng,4 Jianglin Xiang,2,&ast; Shuliang Guo4,&ast; 1Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China; 2Department of Infectious Disease, Chongqing University Three Gorges Hospital, Chongqing, 404000, People’s Republic of China; 3Department of Oncology, Chongqing University Three Gorges Hospital, Chongqing, 404000, People’s Republic of China; 4Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Shuliang Guo, Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China, Tel +86-23-89012097, Email GUOSL_999@163.com Jianglin Xiang; Yongli Wang, Tel +86 13896328822; +86 15213571077, Email 1448026879@qq.com; wyl068@foxmail.comPurpose: To investigate the computed tomography (CT) findings of SARs-CoV-2 Omicron variant in relation to respiratory viral loads determined by cycle threshold values in reverse-transcription polymerase chain reaction (RT-PCR).Materials and Methods: From October 2022 to November 2022, 74 hospitalized patients with Omicron were included in this retrospective study. The radiological features, CT involvement scores in relation to the respiratory viral load, and factors associated with imaging progression (IP) after the RT-PCR results turned negative were analyzed.Results: The most common CT patterns of Omicron were multiple round-like or patchy ground-glass opacity (GGO) or mixed GGO in the peripheral or diffuse areas. The grading of CT involvement scores exhibited an inverse pattern compared to viral loads from day 1 to day 8 and from day 13 to day 20 after diagnosis. Among the 65 patients with complete imaging data, 45 (69.23%) showed IP with clinical warning indicators of disease exacerbation negative in 34 and positive in 11. Patients with IP were older than those with non-IP (NIP); the erythrocyte sedimentation rates, procalcitonin levels, and D-dimer levels on admission of patients with IP were significantly higher than those of patients with NIP, whereas the immunoglobulin (Ig) G antibody level on admission and CT involvement score on initial CT of patients with IP were significantly lower than those of patients with NIP (all P < 0.05).Conclusion: For patients with Omicron, the IP of lung abnormalities is common when the viral load decreases. Under these circumstances, paying attention to clinical warming indicators of disease progression may contribute to better patient management and the mitigation of severe pneumonia.Keywords: severe acute respiratory syndrome coronavirus-2, Omicron, pneumonia, computed tomography, viral load

Introduction: The empiric use of antibiotics in Coronavirus Disease-2019 (COVID-19) infection is not routinely recommended unless a secondary bacterial infection is suspected or confirmed. However, there have been reports of widespread antibiotic use in COVID-19 patients, despite a low rate of secondary bacterial co-infection. Therefore, this study aims to understand the factors influencing the empirical prescription of antibacterial drugs in Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) confirmed COVID-19 patients in Indian settings, as the available data is sparse and conflicting. Aim: To determine the factors associated with antibacterial prescription in patients with proven COVID-19 infection at a tertiary care hospital. Materials and Methods: An antibacterial surveillance study was conducted at Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India. The study duration was two months, from September 2020 to October 2020. The study included COVID-19 patients admitted to critical and non-critical COVID-19 Care Units. Patient data, including demographics, general and systemic examination details, biochemistry, pathological and microbiological reports, and treatment details, were collected using a specially designed form. Patients who were prescribed antibacterial drugs (other than repurposed antibacterial drugs for COVID-19 treatment) were considered as cases, while the rest were classified as controls. The Hazard Ratio (HR) for factors associated with antibacterial prescription was estimated using Cox regression analysis with the Statistical Package for Social Sciences (SPSS) version 20.0. Results: The study included 200 patients, of whom 45 (22.5%) received antibacterial drugs and were classified as cases, while the remaining 155 (77.5%) received antibacterial drugs and were classified as controls. The median age of cases and controls was 59 and 46 years, respectively. Cox regression analysis showed that procalcitonin >1 ng/mL (HR: 1.074, 95% Confidence Interval [CI]: 1.009-1.142, p-value=0.02) and admission to the critical care unit were independent predictors of antibacterial prescription. Additionally, high-dose steroid use (>120 mg/day of Methylprednisolone [MPS]) was associated with a 20% higher risk of antibacterial prescription, although the values were statistically non-significant (HR: 1.203, 95% CI: 0.503-2.879, p=0.678). Conclusion: Admission to critical care units and procalcitonin levels >1 ng/mL were identified as independent predictors of antibacterial prescription in COVID-19 patients. Compliance with hospital-based standard treatment guidelines promotes the rational use of antibacterial drugs.

The multifaceted long-term impairments resulting from critical illness and COVID-19 require interdisciplinary management approaches in the recovery phase of illness. Operational insights into the structure and process of recovery clinics (RCs) from heterogeneous health systems are needed. This study describes the structure and process characteristics of existing and newly implemented ICU-RCs and COVID-RCs in a subset of large health systems in the United States.DesignCross-sectional survey.SettingThirty-nine RCs, representing a combined 156 hospitals within 29 health systems participated.PatientsNone.InterventionsNone.Measurement and main resultsRC demographics, referral criteria, and operating characteristics were collected, including measures used to assess physical, psychologic, and cognitive recoveries. Thirty-nine RC surveys were completed (94% response rate). ICU-RC teams included physicians, pharmacists, social workers, physical therapists, and advanced practice providers. Funding sources for ICU-RCs included clinical billing (n = 20, 77%), volunteer staff support (n = 15, 58%), institutional staff/space support (n = 13, 46%), and grant or foundation funding (n = 3, 12%). Forty-six percent of RCs report patient visit durations of 1 hour or longer. ICU-RC teams reported use of validated scales to assess psychologic recovery (93%), physical recovery (89%), and cognitive recovery (86%) more often in standard visits compared with COVID-RC teams (psychologic, 54%; physical, 69%; and cognitive, 46%).ConclusionsOperating structures of RCs vary, though almost all describe modest capacity and reliance on volunteerism and discretionary institutional support. ICU- and COVID-RCs in the United States employ varied funding sources and endorse different assessment measures during visits to guide care coordination. Common features include integration of ICU clinicians, interdisciplinary approach, and focus on severe critical illness. The heterogeneity in RC structures and processes contributes to future research on the optimal structure and process to achieve the best postintensive care syndrome and postacute sequelae of COVID outcomes.

BackgroundEarly evaluations of healthcare professional (HCP) COVID-19 risk occurred during insufficient personal protective equipment and disproportionate testing, contributing to perceptions of high patient-care related HCP risk. We evaluated HCP COVID-19 seropositivity after accounting for community factors and coworker outbreaks.MethodsPrior to universal masking, we conducted a single-center retrospective cohort plus cross-sectional study. All HCP (1) seen by Occupational Health for COVID-like symptoms (regardless of test result) or assigned to (2) dedicated COVID-19 units, (3) units with a COVID-19 HCP outbreak, or (4) control units from 01/01/2020 to 04/15/2020 were offered serologic testing by an FDA-authorized assay plus a research assay against 67 respiratory viruses, including 11 SARS-CoV-2 antigens. Multivariable models assessed the association of demographics, job role, comorbidities, care of a COVID-19 patient, and geocoded socioeconomic status with positive serology.ResultsOf 654 participants, 87 (13.3%) were seropositive; among these 60.8% (N = 52) had never cared for a COVID-19 patient. Being male (OR 1.79, CI 1.05-3.04, p = 0.03), working in a unit with a HCP-outbreak unit (OR 2.21, CI 1.28-3.81, p

COVID-19 is a spectrum of clinical symptoms in humans caused by infection with SARS-CoV-2. The coalescence of SARS-CoV-2 with seasonal respiratory viruses, particularly influenza viruses, is a global health concern. To understand this, transgenic mice expressing the human ACE2 receptor (K18-hACE2) were infected with influenza A virus (IAV) followed by SARS-CoV-2 and the host response and effect on virus biology was compared to K18-hACE2 mice infected with IAV or SARS-CoV-2 alone. The sequentially infected mice showed reduced SARS-CoV-2 RNA synthesis, yet exhibited more rapid weight loss, more severe lung damage and a prolongation of the innate response compared to the singly infected or control mice. Sequential infection also exacerbated the extrapulmonary encephalitic manifestations associated with SARS-CoV-2 infection. Conversely, prior infection with a commercially available, multivalent live-attenuated influenza vaccine (Fluenz Tetra) elicited the same reduction in SARS-CoV-2 RNA synthesis, albeit without the associated increase in disease severity. This suggests that the innate immune response stimulated by IAV inhibits SARS-CoV-2. Interestingly, infection with an attenuated, apathogenic influenza vaccine does not result in an aberrant immune response and enhanced disease severity. Taken together, the data suggest coinfection (‘twinfection’) is deleterious and mitigation steps should be instituted as part of the comprehensive public health and management strategy of COVID-19.

Coronaviruses (members of the Coronaviridae family) are prominent in veterinary medicine, with several known infectious agents commonly reported. In contrast, human medicine has disregarded coronaviruses for an extended period. Within the past two decades, coronaviruses have caused three major outbreaks. One such outbreak was the coronavirus disease 2019 (COVID-19) caused by the coronavirus severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Over the 3-year COVID-19 outbreak, several instances of zooanthroponosis have been documented, which pose risks for virus modifications and possible re-emergence of the virus into the human population, causing a new epidemic and possible threats for vaccination or treatment failure. Therefore, widespread screening of animals is an essential technique for mitigating future risks and repercussions. However, mass detection of SARS-CoV-2 in wild animals might be challenging. In silico prediction modeling, experimental studies conducted on various animal species, and natural infection episodes recorded in various species might provide information on the potential threats to wildlife. They may be useful for diagnostic and mass screening purposes. In this review, the possible methods of wildlife screening, based on experimental data and environmental elements that might play a crucial role in its effective implementation, are reviewed.

We analyzed 1,303 SARS-CoV-2 whole-genome sequences from Vietnam, and found the Alpha and Delta variants were responsible for a large nationwide outbreak of COVID-19 in 2021. The Delta variant was confined to the AY.57 lineage and caused >1.7 million infections and >32,000 deaths. Viral transmission was strongly affected by nonpharmaceutical interventions.

The emergence of the Omicron variant in November 2021, has caused panic worldwide due to the rapid evolution and the ability of the virus to escape the immune system. Since, several Omicron sublineages (BA.1 to BA.5) and their descendent recombinant lineages have been circulating worldwide. Furthermore, in December 2022, a new Omicron subvariant XBB.1.5 characterized by an unusual mutation in the spike protein evolved in the United States and rapidly spread to the other continents. Our study reports on the first cases of XBB.1.5 sublineage among indigenous Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-COV-2) positive cases detected through the influenza sentinel surveillance system in Niger. All influenza suspected cases were tested for both influenza and SARS-COV-2 using the Centre for Disease Control and prevention (CDC) Influenza SARS-COV-2 Multiplex quantitative Reverse-Transcription Polymerase Chain Reaction (qRT-PCR) Assay. SARS-COV-2 positive samples with cycle threshold ≤28 were selected for whole genome sequencing subsequently using the Oxford Nanopore Midnight protocol with rapid barcoding on a MinIon MK1B device. A total of 51 SARS-COV-2 positive samples were confirmed between December 2022 and March 2023. We successfully obtained 19 sequences with a predominance of the XBB.1/XBB.1.5 sublineages (73.7 %). In addition, a recombinant XBD sequence was also first-ever identified in early March 2023. Our findings support the need to strengthen the influenza sentinel surveillance for routine Coronavirus Disease 2019 (COVID-19) surveillance and SARS-COV-2 variants monitoring in Niger.

Introduction: Several reports have noted that severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) induced lymphopenia in coronavirus disease 2019 (COVID-19) patients. However, the clinical significance of lymphopenia remains unclear. The objective of this study was to analyze the association between lymphopenia at an early stage and the prognosis of COVID-19 patients. Material and methods: All 192 hospitalized patients with COVID-19 were enrolled. Demographic data and clinical characteristics were collected and patient's prognosis was followed up. Results: On admission, 84 (43.8%) patients suffered from lymphopenia among COVID-19 patients. The count and percentage of lymphocytes on admission were lower among patients over 70 years old than those of younger patients. Multivariate logistic regression revealed that older age was a risk factor of lymphopenia. Of interest, chest CT score, a key marker of lung injury, was increased among COVID-19 patients with lymphopenia. By contrast, PaCO2, SpO2 and oxygenation index, several respiratory function markers, were decreased in COVID-19 patients with lymphopenia. Moreover, total bilirubin (TBIL) and direct bilirubin (DBIL), two markers of hepatic injury, creatinine and urea nitrogen, two indices of renal function, and creatine kinase, AST and LDH, three myocardial enzymes, were elevated in COVID-19 patients with lymphopenia. Among 84 COVID-19 patients with lymphopenia, 32.1% died. The fatality rate was obviously higher in COVID-19 patients with lymphopenia. Conclusions: Older COVID-19 patients are more susceptible to lymphopenia. Multiple organ injuries were more serious in COVID-19 patients with lymphopenia. Lymphopenia at an early stage aggravates the severity and elevates the death risk of COVID-19 patients. [ABSTRACT FROM AUTHOR]

This systematic review and network meta-analysis (NMA) comprehensively compared the effectiveness of different mouth rinses in reducing the viral load/infectivity of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) (Part I), alleviating clinical symptoms or severity of disease (Part II), and decreasing the incidence of SARS-CoV-2 infection (Part III). Randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) with restrictions were searched up to 3rd March 2023. Twenty-three studies (22 RCTs and one NRCT) met the inclusion criteria for this systematic review. Five RCTs (454 patients and nine interventions) in Part I were eligible for NMA. The NMA results showed that, in comparison with no rinse, sodium chloride (NaCl) was the most effective mouth rinse for reducing the viral load, followed by povidone-iodine (PVP-I), ß-cyclodextrin + citrox (CDCM), hydrogen peroxide (HP), chlorhexidine gluconate (CHX), cetylpyridinium chloride (CPC), placebo and hypochlorous acid (HClO). However, these results were not significant. Based on surface under the cumulative ranking curve scores, PVP-I was likely to be the most efficacious mouth rinse for reducing SARS-CoV-2 viral load, followed by CDCM, HP, NaCl, CHX, CPC, placebo, no rinse and HClO. Due to heterogeneity of the primary studies, the effectiveness of different mouth rinses to reduce viral infectivity, improve clinical symptoms or prevent SARS-CoV-2 infection remains inconclusive. [ABSTRACT FROM AUTHOR]

Background: Many cases of multisystem inflammatory syndrome in children (MIS-C) are reported in post-COVID-19 cases. It is a serious complication of COVID-19, with a high mortality rate in low-income countries compared to high-income countries. This study was conducted to find out predictors of mortality in MIS-C. Subjects and Methods: In this prospective observational study, 81 children with MIS-C were enrolled. Detailed clinical features, laboratory parameters, treatment, and outcome of cases were recorded. After the determination of individual factors associated with mortality by univariate analysis, a binary logistic regression model of significant factors associated with mortality was developed. Results: Fever, breathlessness, conjunctivitis, and pain abdomen were major presenting complaints at admission. Fifty-seven (70.3%) were presented with shock, of which 31 (54.4%) had normotensive shock and 26 (45.6%) had hypotensive shock. There were 8 (9.8%) deaths in the study group. Association of pneumonia, acute respiratory distress syndrome, and acute kidney injury were significantly high among nonsurvivors. Levels of lactate dehydrogenase (LDH), interleukin-6, and prothrombin time (international normalized ratio) were significantly higher in nonsurvivors than survivors. On binary logistic regression, raised LDH and the use of a mechanical ventilator were found to be independent predictors of death (P < 0.05). Conclusions: Shock was the predominant manifestation in children with MIS-C. Raised LDH and the use of mechanical ventilators were found to be independent predictors of death in cases of MIS-C. [ABSTRACT FROM AUTHOR]

Introduction: The empiric use of antibiotics in Coronavirus Disease-2019 (COVID-19) infection is not routinely recommended unless a secondary bacterial infection is suspected or confirmed. However, there have been reports of widespread antibiotic use in COVID-19 patients, despite a low rate of secondary bacterial co-infection. Therefore, this study aims to understand the factors influencing the empirical prescription of antibacterial drugs in Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) confirmed COVID-19 patients in Indian settings, as the available data is sparse and conflicting. Aim: To determine the factors associated with antibacterial prescription in patients with proven COVID-19 infection at a tertiary care hospital. Materials and Methods: An antibacterial surveillance study was conducted at Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India. The study duration was two months, from September 2020 to October 2020. The study included COVID-19 patients admitted to critical and non-critical COVID-19 Care Units. Patient data, including demographics, general and systemic examination details, biochemistry, pathological and microbiological reports, and treatment details, were collected using a specially designed form. Patients who were prescribed antibacterial drugs (other than repurposed antibacterial drugs for COVID-19 treatment) were considered as cases, while the rest were classified as controls. The Hazard Ratio (HR) for factors associated with antibacterial prescription was estimated using Cox regression analysis with the Statistical Package for Social Sciences (SPSS) version 20.0. Results: The study included 200 patients, of whom 45 (22.5%) received antibacterial drugs and were classified as cases, while the remaining 155 (77.5%) received antibacterial drugs and were classified as controls. The median age of cases and controls was 59 and 46 years, respectively. Cox regression analysis showed that procalcitonin >1 ng/mL (HR: 1.074, 95% Confidence Interval [CI]: 1.009-1.142, p-value=0.02) and admission to the critical care unit were independent predictors of antibacterial prescription. Additionally, high-dose steroid use (>120 mg/day of Methylprednisolone [MPS]) was associated with a 20% higher risk of antibacterial prescription, although the values were statistically non-significant (HR: 1.203, 95% CI: 0.503-2.879, p=0.678). Conclusion: Admission to critical care units and procalcitonin levels >1 ng/mL were identified as independent predictors of antibacterial prescription in COVID-19 patients. Compliance with hospital-based standard treatment guidelines promotes the rational use of antibacterial drugs. [ABSTRACT FROM AUTHOR]

We investigated a large outbreak of SARS-CoV-2 infections among passengers and crew members (60 cases in 132 persons) on a cruise ship sailing for 7 days on rivers in the Netherlands. Whole-genome analyses suggested a single or limited number of viral introductions consistent with the epidemiologic course of infections. Although some precautionary measures were taken, no social distancing was exercised, and air circulation and ventilation were suboptimal. The most plausible explanation for introduction of the virus is by persons (crew members and 2 passengers) infected during a previous cruise, in which a case of COVID-19 had occurred. The crew was insufficiently prepared on how to handle the situation, and efforts to contact public health authorities was inadequate. We recommend installing clear handling protocols, direct contacts with public health organizations, training of crew members to recognize outbreaks, and awareness of air quality on river-cruise ships, as is customary for most seafaring cruises.

We assessed susceptibility of dogs to SARS-COV-2 Delta and Omicron variants by experimentally inoculating beagle dogs. Moreover, we investigated transmissibility of the variants from infected to naive dogs. The dogs were susceptible to infection without clinical signs and transmitted both strains to other dogs through direct contact.

Objective: An observational, retrospective, institution-based study to observe the pattern of ivermectin use related to patients’ characteristics. Methods: Patient data including short-term diagnosis, investigations done, and drug usage data were captured in a predesigned, structured case report form; and suspected adverse events were recorded in the standard suspected adverse drug reaction reporting form recommended by the “Central Drug Standard Control Organization,” India. The study was for a period of 7 months from August 01, 2020, to February 28, 2021. A total of 4,552 patients were recruited in this study and followed up till their discharge or death. The comparison was made between not given and given of ivermectin among patients. Results: Data were summarized by routine descriptive and statistical analysis. The mean age (years), length of stay (days) onset from hospitalization, pulse rate, systolic blood pressure (SBP), and temperature did not show significant change. However, respiratory rate was found to decrease significantly (p < 0.001), and oxygen saturation (SpO2) was found to increase significantly (p < 0.001) in the ivermectin-treated group. It was also observed that a positive correlation with a highly significant value (p < 0.000) between age (years), length of stay (days) onset from, pulse rate, SBP, and temperature and ivermectin usage while a negative correlation with highly significant value (p < 0.000) between SpO2 and ivermectin usage was obtained. Conclusion: As per the studied parameters, a significant correlation was observed in combinations of the treated and untreated groups. Further research suggested the dose-dependent efficacy of ivermectin usage in the novel coronavirus disease-2019 patients.

Abstract Background No clear evidence exists regarding the effects of the different periods and magnitude of spread of the COVID‐19 infection on cancer treatments. This study investigated the effects of the different periods and magnitude of COVID‐19 infection spread on in‐hospital cancer operations. Methods Medical claims data from 17 hospitals where in‐hospital operations for patients with malignant neoplasms were performed between 1 April 2017 and 31 March 2021 in Yamagata were extracted and analyzed. The critical time points as exposure used to evaluate the impact of different COVID‐19 infection spread periods on cancer operations were (1) April 2020 (emergency declaration introduced by the government) and (2) December 2020 (the second wave). From April to November 2020 and December 2020 to March 21, the number of confirmed COVID‐19 cases was 130 and 840, respectively. The 17 hospitals were classified into intervention or control groups based on whether in‐hospital treatments for patients with COVID‐19 were provided. Results The interrupted time series analysis reported that the difference in the trend of pre‐COVID‐19 and postsecond wave (March 2020 to December 2020) periods was statistically significant between groups, with 50.67 fewer operations (95% confidence interval [CI] = 12.19–89.15) performed per month in the intervention group compared with the control group. Moreover, the immediate change in the number of operations in April 2020 (beginning of the first wave) was statistically significant between groups, with 80.14 operations (95% CI = 39.62–120.67) less immediately after the first wave in the intervention group compared with the control group. Conclusion Our findings suggest that a statement of emergency by the government and the COVID‐19 infection spread are both associated with the number of cancer operations performed in the Yamagata prefecture during the COVID‐19 pandemic.

Background and Aim: The coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that attacks the respiratory and digestive tract. The SARS-CoV-2 showed systemic characteristics with various clinical symptoms from subclinical to fatal (causing death). Transmission of SARS-CoV-2 has been reported to occur from humans to pets (cats, dogs, tigers, ferrets, and poultry). Knowledge about the role of domestic animals in the transmission of SARS-CoV-2 to humans, and as reservoirs of this virus needs to be investigated further. This study aimed to detect the presence of SARS-CoV-2 in domestic animals such as dogs, cats, pigs, cows, birds, and bats that are often in contact with humans. Materials and Methods: A total of 157 samples, which included nasopharyngeal and oropharyngeal swabs, along with sera samples from domestic animals such as cats, pigs, cows, birds, and bats, were taken from Veterinary Hospitals, Veterinary Clinics, and farms around the Yogyakarta region. Detection of the virus was done using rapid detection of viral antigens, antibodies, and reverse transcriptase-polymerase chain reaction (RT-PCR) technique. Results: The results showed that 5/157 (3.1%) samples found positive against the COVID-19 virus using a rapid antibody test; however, the results were negative on the rapid antigen and RT-PCR tests. Antibody-positive samples came from animals that had a history of household COVID-19 human infection. Conclusion: Thus, findings of the present study conclude that there is a potential for transmission of the COVID-19 virus between animals and humans.