Acute Respiratory Syndrome Coronavirus Disease Research Articles

Household COVID-19 secondary attack rate and associated determinants in Pakistan; A retrospective cohort study.

BackgroundCOVID-19 household transmissibility remains unclear in Pakistan. To understand the dynamics of Severe Acute Respiratory Syndrome Coronavirus disease epidemiology, this study estimated Secondary Attack Rate (SAR) among household and close contacts of index cases in Pakistan using a statistical transmission model.MethodologyA retrospective cohort study was conducted using an inclusive contact tracing dataset from the provinces of Punjab and Khyber-Pakhtunkhwa to estimate SAR. We considered the probability of an infected person transmitting the infection to close contacts regardless of residential addresses. This means that close contacts were identified irrespective of their relationship with the index case. We assessed demographic determinants of COVID-19 infectivity and transmissibility. For this purpose based on evolving evidence, and as CDC recommends fully vaccinated people get tested 5–7 days after close contact with a person with suspected or confirmed COVID-19. Therefore we followed the same procedure in the close contacts for secondary infection.FindingsDuring the study period from 15th May 2020 to 15th Jan 2021, a total of 339 (33.9%) index cases were studied from 1000 cases initially notified. Among close contact groups (n = 739), households were identified with an assumed mean incubation period of 8.2+4.3 days and a maximum incubation period of 15 days. SAR estimated here is among the household contacts. 117 secondary cases from 739 household contacts, with SAR 11.1% (95% CI 9.0–13.6). All together (240) SAR achieved was 32.48% (95% CI; 29.12–37.87) for symptomatic and confirmed cases. The potential risk factors for SAR identified here included; old age group (>45 years of age), male (gender), household members >5, and residency in urban areas and for index cases high age group. Overall local reproductive number (R) based on the observed household contact frequencies for index/primary cases was 0.9 (95% CI 0.47–1.21) in Khyber Pakhtunkhwa and 1.3 (95% CI 0.73–1.56) in Punjab.ConclusionsSAR estimated here was high especially in the second phase of the COVID-19 pandemic in Pakistan. The results highlight the need to adopt rigorous preventive measures to cut the chain of viral transmission and prevent another wave of COVID-19.

Multisystem Inflammatory Syndrome in Children and Acute Kidney Injury: Retrospective Study of Five Italian PICUs.

Multisystem inflammatory syndrome in children (MIS-C) manifests with heart dysfunction and respiratory failure some weeks after a severe acute respiratory syndrome coronavirus disease 2 infection. The aim of our study was to explore the prevalence, severity, timing, and duration of acute kidney injury (AKI) in MIS-C patients. Furthermore, we evaluated which clinical variables and outcomes are associated with AKI. Multicenter retrospective study. Five tertiary hospital PICUs in Italy. Data were collected in the first 7 days of PICU admission and renal function was followed throughout the hospital stay. Patients less than 18 years old admitted to the PICU for greater than 24 hours with MIS-C. None. We collected the following data, including: demographic information, inflammatory biomarkers, lactate levels, Pa o2 /F io2 , ejection fraction, N-terminal pro-B-type natriuretic peptide (NT-proBNP), renal function (serum creatinine, urinary output, fluid balance, and percentage fluid accumulation), Vasoactive-Inotropic Score (VIS), pediatric Sequential Organ Failure Assessment (pSOFA), and Pediatric Index of Mortality 3. AKI was diagnosed in eight of 38 patients (21%) and severe AKI was present in four of eight patients. In all cases, AKI was present at PICU admission and its median (interquartile range) duration was 3.5 days (1.5-5.7 d). We did not identify differences between AKI and no-AKI patients when not making correction for multiple comparisons, for example, in weight, ejection fraction, pSOFA, Pa o2 /F io2 , and lactates. We failed to identify any difference in these groups in urine output and fluid balance. Exploratory analyses of serial data between no-AKI and AKI patients showed significant differences on lymphocyte count, NT-proBNP value, ejection fraction, pSOFA, Pa o2 /F io2 , and VIS. In this multicenter Italian PICU experience, MIS-C is associated with AKI in one-in-five cases. In general, AKI is characterized by an associated reduction in glomerular filtration rate with a self-limiting time course.

Nosocomial transmission of hepatitis E virus and development of chronic infection: The wider impact of COVID-19.

BackgroundTransmission of hepatitis E virus (HEV) within the healthcare setting is extremely rare. Additionally, the development of chronic HEV infection in association with severe acute respiratory syndrome coronavirus disease 2 (SARS-CoV-2) infection and/or its immunomodulatory therapy has not been reported previously.AimsTo describe the investigation and management of a nosocomial HEV transmission incident during the coronavirus disease 2019 (COVID-19) pandemic.MethodsEpidemiological and molecular investigation of two individuals hospitalised with COVID-19 who were both diagnosed with HEV infection.ResultsFindings from our investigation were consistent with transmission of HEV from one patient with a community-acquired HEV infection to another individual (identical HEV sequences were identified in the two patients), most likely due to a breach in infection control practices whilst both patients shared a bed space on the intensive care unit (ICU). Chronic HEV infection requiring treatment with ribavirin developed in one patient with prolonged lymphopaenia attributable to COVID-19 and/or the immunomodulators received for its treatment. Further investigation did not identify transmission of HEV to any other patients or to healthcare workers.ConclusionsThe extraordinary demands that the COVID-19 pandemic has placed on all aspects of healthcare, particularly within ICU settings, has greatly challenged the ability to consistently maintain optimal infection prevention and control practices. Under the significant pressures of the COVID-19 pandemic a highly unusual nosocomial HEV transmission incident occurred complicated further by progression to a chronic HEV infection in one patient.

Identification of bioactive molecules from Triphala (Ayurvedic herbal formulation) as potential inhibitors of SARS-CoV-2 main protease (Mpro) through computational investigations

Severe acute respiratory syndrome coronavirus disease (SARS-CoV-2) induced coronavirus disease 2019 (COVID-19) pandemic is the present worldwide health emergency. The global scientific community faces a significant challenge in developing targeted therapies to combat the SARS-CoV-2 infection. Computational approaches have been critical for identifying potential SARS-CoV-2 inhibitors in the face of limited resources and in this time of crisis. Main protease (Mpro) is an intriguing drug target because it processes the polyproteins required for SARS-CoV-2 replication. The application of Ayurvedic knowledge from traditional Indian systems of medicine may be a promising strategy to develop potential inhibitor for different target proteins of SARS-CoV-2. With this endeavor, we docked bioactive molecules from Triphala, an Ayurvedic formulation, against Mpro followed by molecular dynamics (MD) simulation (100 ns) to investigate their inhibitory potential against SARS-CoV-2. The top four best docked molecules (terflavin A, chebulagic acid, chebulinic acid, and corilagin) were selected for MD simulation study and the results obtained were compared to native ligand X77. From docking and MD simulation studies, the selected molecules showed promising binding affinity with the formation of stable complexes at the active binding pocket of Mpro and exhibited negative binding energy during MM-PBSA calculations, indication their strong binding affinity with the target protein. The identified bioactive molecules were further analyzed for drug-likeness by Lipinski’s filter, ADMET and toxicity studies. Computational (in silico) investigations identified terflavin A, chebulagic acid, chebulinic acid, and corilagin from Triphala formulation as promising inhibitors of SARS-CoV-2 Mpro, suggesting experimental (in vitro/in vivo) studies to further explore their inhibitory mechanisms.

Incidence of deep venous thrombosis in patients with severe acute respiratory syndrome coronavirus disease 2019 and elevated plasma levels of the D-dimer

Background There is an increased risk of developing venous thromboembolism in patients with severe acute respiratory syndrome coronavirus disease (SARS COVID-19). As the D-dimer could be elevated in deep venous thrombosis (DVT), we aimed to investigate the incidence of DVT in patients with SARS COVID-19 and elevated plasma levels of the D-dimer. Patients and methods A prospective observational study was carried out to screen all patients with a confirmed diagnosis of SARS COVID-19 with plasma D-dimer levels above 1000 ng/ml for the presence of DVT without related symptoms using complete compression Doppler ultrasound. Results A total of 52 patients were included in the study. Among them, 34 (67.3%) were males. All patients received standardized thromboprophylaxis treatment. The screening results of complete compression Doppler ultrasound revealed DVT in eight (15.4%) patients. Among these patients, the DVT was proximal in one (1.9%) patient and bilateral distal in two (3.8%) patients. The D-dimer level was significantly higher in patients with DVT than in patients without DVT (4531 vs. 2048 ng/ml, odds ratio 9.4, 95% confidence interval 1.2–70.3). The diagnostic ability of the D-dimer was satisfactory, with an receiver operating characteristic curve of 0.71 (95% confidence interval 0.62–0.83). Conclusion The incidence of DVT without symptoms in patients with SARS COVID-19 and elevated plasma level of D-dimer was 15.4%, with a significant difference between patients with and without DVT in terms of the D-dimer. Therefore, the D-dimer is important for the diagnosis of DVT in patients with SARS COVID-19.

Effectiveness of COVID-19 Vaccines against SARS-CoV-2 Infection among Persons Attending the RT-PCR center at a Medical College Hospital in Telangana: A Case- Control Study.

In January 2021, India's drug regulator issued restricted emergency approval for COVISHIELD and COVAXIN, which were manufactured in India. In mid-January 2021, in India, there were 10.5 million confirmed cases and 0.15 million deaths. The objectives were to evaluate vaccine effectiveness (VE) of coronavirus disease 2019 (COVID-19) vaccines made in India against severe acute respiratory syndrome coronavirus disease 2 (SARS-CoV-2) infection. A test-negative case-control study was conducted from May 2021 to December 2021 for a duration of 8 months among people attending a reverse transcriptase polymerase chain reaction (RT-PCR) center at a medical college hospital for RT-PCR test for SARS-CoV-2. The baseline characteristics and RT-PCR report were collected from the RT-PCR center. The exposure to COVID-19 vaccines was enquired via phone call or was checked with data available with the health authorities. After applying inclusion and exclusion criteria and case and control definitions, a total of 380 participants (95 cases and 285 controls) were included. The adjusted VE of two doses of COVISHIED vaccine against symptomatic SARS-CoV-2 infection was 52.2% (41.7 to 62.1), and that of a single dose was 40.88% (31.26 to 51.29). The adjusted VE of two doses of COVAXIN vaccine against SARS-CoV-2 infection was 39% (29.40 to 49.27). The overall VE was 48.20% (37.90 to 58.22) for two doses of any vaccines. Vaccines made in India were nearly 50% effective. Further new studies should be conducted as new variants of SARS-CoV-2 are emerging. We do not know the VE against the variants, and whether booster doses are required or not is not yet established.

Evaluation and correlation of laboratory, radiological markers, and cytokine inflammation in patients with severe acute respiratory syndrome coronavirus disease 2019

Aim and objectiveFever and lymphocyte count to start the interventions and not wait for the upregulation of IL-6 and down regulation of SpO2 levels amongst the patients.BackgroundIn SARS-CoV-2 host immune response play a critical role in disease pathogenesis. The coronavirus not only activates antiviral immune responses, but it can also cause uncontrolled inflammatory responses categorized by marked proinflammatory cytokine release in patients with severe COVID-19, leading to lymphopenia. In this present article we have studied the basic parameters of COVID-19 that includes fever and lymphocyte count and their deep association with markers of disease prognosis and cytokine storm such as IL-6, HRCT score and SpO2 levels. With this basic routine clinical and laboratory parameters we can consider recurrent/prolonged fever and low count of lymphocytes are the earliest biomarkers of the upcoming cytokine storm.MethodWe conducted a hospital-based case-control study of patients who visited to the tertiary healthcare centre in Amravati (Maharashtra), India with a positive SARS-CoV-2 polymerase chain reaction (PCR) assay, from August 01, 2020 to July 03, 2021. Upon hospital visit, all patients underwent a HRCT chest score, complete blood count (CBCs), renal and liver panel, IL-6. Patients with fever and other symptoms which were not responsive to the treatment were admitted to the hospital. Patients who tested positive and admitted to the hospital were not discharged until they had 2 negative RTPCR tests 24 hours apart. Patient details including demographics, history of comorbidities associated with every patient, the records of the vital signs, symptoms and all the reports of radiological and blood assays were obtained from computerized medical records of the hospital.ResultsWe screened total 1324 patients admitted to Tertiary health care center Amravati (Maharashtra), India, from 01 August 2020 to 03 July 2021. From these study, total 156 patients are excluded because of the number of patients, i.e. 106/156 patients founded with no prolonged fever but having same common symptoms. And remaining 50 patients excluded because of they were found with no short duration of fever and asymptomatic. Data was collected from the remaining 1168 (88.21%) as a cohort control group. The cases with recurrent/prolonged fever and short duration had median age [52 (21-83) v/s 52 (17-92) p=0.42] it shows that age is not statistically significant. On the other hand, the cases with recurrent/prolonged fever were more likely to have hypoxia were SpO2 level [90 (50-98)] v/s in short duration of fever were observed.[95 (45-98) p=0.02] shows statistically associated. Similarly, the HRCT chest score in recurrent/prolonged fever were found to be around [8 (0-24)] v/s [6 (0-22) p=0.027] it represents the significant difference.ConclusionFever and lymphocyte count and their deep association with markers of disease prognosis and cytokine storm such as IL-6, HRCT score and SpO2 level. With this basic routine clinical and labortory parameters we can consider recurrent/prolonged fever and low count of lymphocytes are the earliest biomarkers of the upcoming cytokine storm. Therefore, study recommends the use of fever and lymphocyte count to start the interventions and not wait for the upregulation of IL-6 and down regulation of SpO2 which occurs in late stage.

Clinical Presentation and Course of SARS-CoV-2 Infection in Health-Care Personnel Working in Dedicated COVID-19 Hospital During 2 Pandemic Waves in India.

Health-care personnel (HCPs) are predisposed to infection during direct or indirect patient care as well as due to the community spread of the disease. We observed the clinical presentation and course of severe acute respiratory syndrome coronavirus disease 2 (SARS-CoV-2) infection in HCPs working in a dedicated coronavirus disease 2019 (COVID-19) care hospital during the first and the second wave. A total of 100 and 223 HCPs were enrolled for the first wave and the second wave, respectively. Cough, shortness of breath, sore throat, runny nose, and headache was seen in 40 (40%) and 152 (68%) (P < 0.01), 15 (15%) and 64 (29%) (P = 0.006), 40 (40%) and 119 (53.3%) (P = 0.03), 9 (9%) and 66 (30%) (P < 0.01), 20 (20%) and 125 (56%) (P < 0.01), respectively. Persistent symptoms at the time of joining back to work were seen in 31 (31%) HCPs and 152 (68%) HCPs, respectively (P ≤ 0.01). Reinfection was reported in 10 HCPs. Most of the HCPs had mild to moderate infections. Symptoms persist after joining back to work. Upgradation of home-based care and teleconsultation facilities for active disease and redressal of residual symptoms will be helpful.

Age-Stratified Risk of Cerebral Venous Sinus Thrombosis After SARS-CoV-2 Vaccination.

Cerebral venous sinus thrombosis (CVST) as a part of the thrombosis and thrombocytopenia syndrome is a rare adverse drug reaction of severe acute respiratory syndrome coronavirus disease 2 (SARS-CoV-2) vaccination. Estimated background rate of CVST with thrombocytopenia is 0.1 per million per month. We assessed the age-stratified risk of CVST with and without thrombocytopenia after SARS-CoV-2 vaccination. We estimated the absolute risk of CVST with and without thrombocytopenia within 28 days of a first dose of 4 SARS-CoV-2 vaccinations using data from the European Medicines Agency's EudraVigilance database (until June 13, 2021). As a denominator, we used data on vaccine delivery from 31 European countries. For 22.8 million adults from 25 countries, we estimated the absolute risk of CVST after the first dose of ChAdOx1 nCov-19 per age category. The absolute risk of CVST within 28 days of first-dose vaccination was 7.5 (95% confidence interval [CI] 6.9-8.3), 0.7 (95% CI 0.2-2.4), 0.6 (95% CI 0.5-0.7), and 0.6 (95% CI 0.3-1.1) per million of first doses of ChAdOx1 nCov-19, Ad26.COV2.S, BNT162b2, and mRNA-1273, respectively. The absolute risk of CVST with thrombocytopenia within 28 days of first dose vaccination was 4.4 (95% CI 3.9-4.9), 0.7 (95% CI 0.2-2.4), 0.0 (95% CI 0.0-0.1), and 0.0 (95% CI 0.0-0.2) per million of first doses of ChAdOx1 nCov-19, Ad26.COV2.S, BNT162b2, and mRNA-1273, respectively. In recipients of ChAdOx1 nCov-19, the absolute risk of CVST, both with and without thrombocytopenia, was the highest in the 18- to 24-year-old group (7.3 per million, 95% CI 2.8-18.8 and 3.7 per million, 95% CI 1.0-13.3, respectively). The risk of CVST with thrombocytopenia in ChAdOx1 nCov-19 recipients was the lowest in the age group ≥70 years (0.2, 95% CI 0.0-1.3). Age <60 years compared to ≥60 years was a predictor for CVST with thrombocytopenia (incidence rate ratio 5.79, 95% CI 2.98-11.24, p < 0.001). The risk of CVST with thrombocytopenia within 28 days of first-dose vaccination with ChAdOx1 nCov-19 was higher in younger age groups. The risk of CVST with thrombocytopenia was slightly increased in patients receiving Ad26.COV2.S compared with the estimated background risk. The risk of CVST with thrombocytopenia was not increased in recipients of SARS-CoV-2 mRNA vaccines.

Paper-Based Biosensors for COVID-19: A Review of Innovative Tools for Controlling the Pandemic.

The appearance and quick spread of the new severe acute respiratory syndrome coronavirus disease, COVID-19, brought major societal challenges. Importantly, suitable medical diagnosis procedures and smooth clinical management of the disease are an emergent need, which must be anchored on novel diagnostic methods and devices. Novel molecular diagnostic tools relying on nucleic acid amplification testing have emerged globally and are the current gold standard in COVID-19 diagnosis. However, the need for widespread testing methodologies for fast, effective testing in multiple epidemiological scenarios remains a crucial step in the fight against the COVID-19 pandemic. Biosensors have previously shown the potential for cost-effective and accessible diagnostics, finding applications in settings where conventional, laboratorial techniques may not be readily employed. Paper- and cellulose-based biosensors can be particularly relevant in pandemic times, for the renewability, possibility of mass production with sustainable methodologies, and safe environmental disposal. In this review, paper-based devices and platforms targeting SARS-CoV-2 are showcased and discussed, as a means to achieve quick and low-cost PoC diagnosis, including detection methodologies for viral genomic material, viral antigen detection, and serological antibody testing. Devices targeting inflammatory markers relevant for COVID-19 are also discussed, as fast, reliable bedside diagnostic tools for patient treatment and follow-up.

DTC genetic test for customized cosmetics in COVID-19 pandemic: Focused on women in their 40s and 60s in Seoul, Republic of Korea.

BackgroundSevere acute respiratory syndrome coronavirus disease 19 (COVID‐19) is attracting worldwide attention and has been declared an infectious disease by the World Health Organization (WHO), and accordingly, interest and meaning in health and well‐being are expanding in recent years.AimsThis paper attempted to investigate the recognition and development potential of customized cosmetics focusing on inner beauty products through DTC (Direct to Customer) genetic testing in the era of COVID‐19 pandemic.Patients/MethodsThe number of women included in the survey of consumers living in Seoul metropolitan city ranged from 40 to 60, and 380 women in Republic of Korea. Statistical processing of the data collected by the data analysis method is analyzed using the Statistical Package for Social Science (SPSS) WIN25.0 statistical package program through the process of data coding and data cleansing.ResultsIn this study, the DTC genetic test, single, and/or combination treatment for customized inner beauty products and customized cosmetics were compared and analyzed, respectively. Accordingly, in keeping with the rapidly changing market conditions, we sought to study customized inner beauty and customized cosmetics recognition and purchasing behavior through DTC genetic testing in the unexplored era after COVID‐19 pandemic. As a result, it was significantly more effective to use customized inner beauty and customized cosmetics after DTC genetic test (p < 0.001).ConclusionThis study emphasizes that after the global COVID‐19 pandemic worldwide that occurred after January 2020, the definition of health persistence, wellness, and well‐dying associated with beauty and cosmetology is also evolving from the DTC genetic test. In our results, it was found for the first time that the intake of customized inner beauty preparations and the use of customized cosmetics would be more effective. In the above significant research results, it is believed that research on the combinational effect of customized inner beauty products and customized cosmetics is required in the global DTC genetic testing market.

Recent advances in the chromatographic determination of the most commonly used anti-hepatitis C drug sofosbuvir and its co-administered drugs in human plasma.

Sofosbuvir is a direct-acting antiviral drug that inhibits hepatitis C virus (HCV) NS5B polymerase, which in turn affects the virus replication inside biological systems. The clinical importance of sofosbuvir is based not only on its effect on HCV but also on other lethal viruses such as Zika and severe acute respiratory syndrome coronavirus disease 2019 (SARS-COVID-19). Accordingly, there is a continuous shedding of light on the development and validation of accurate and fast analytical methods for the determination of sofosbuvir in different environments. This work critically reviews the recent advances in chromatographic methods for the analysis of sofosbuvir and/or its metabolites in pure samples, pharmaceutical dosage forms, and in the presence of other co-administered drugs to highlight the current status and future perspectives to enhance its determination in different matrixes.

Challenges in the Cardiothoracic and Vascular Anesthesia Fellowship Program Since the Coronavirus Disease 2019 (COVID-19) Pandemic: An Electronic Survey on Potential Solutions

ObjectiveThe authors explored the current practice of fellowship training in cardiothoracic and vascular anesthesia and surveyed the acceptability of potential solutions to mitigate the interrupted fellowship training during the severe acute respiratory syndrome coronavirus disease 2019 (COVID-19) pandemic. DesignA prospective electronic questionnaire-based survey. SettingThe survey was initiated by the Education Committee of the European Association of Cardiothoracic Anesthesiology and Intensive Care (EACTAIC). ParticipantsThe study comprised EACTAIC fellows, EACTAIC, and non-EACTAIC subscribers to the EACTAIC newsletter and EACTAIC followers on different social media platforms. InterventionsAfter obtaining the consent of participants, the authors assessed the perioperative management of COVID-19 patients, infrastructural aspects of the workplace, local routines for preoperative testing, the perceived availability of personal protective equipment (PPE), and the impact of COVID-19 on fellowship training. In addition, participants rated suggested solutions by the investigators to cope with the interruption of fellowship training, using a traffic light signal scale. Measurements and Main ResultsThe authors collected 193 responses from 54 countries. Of the respondents, 82.4% reported cancelling or postponing elective cases during the first wave, 89.7% had provided care for COVID-19 patients, 75.1% reported staff in their center being reassigned to work in the intensive care unit (ICU), and 45% perceived a shortage of PPE at their centers. Most respondents reported the termination of local educational activities (79.6%) and fellowship assessments (51.5%) because of the pandemic (although 84% of them reported having time to participate in online teaching), and 83% reported a definitive psychological impact. More than 90% of the respondents chose green and/or yellow traffic lights to rate the importance of the suggested solutions to cope with the interrupted fellowship training during the pandemic. ConclusionsThe COVID-19 pandemic led to the cancellation of elective cases, the deployment of anesthesiologists to ICUs, the involvement of anesthesiologists in perioperative care for COVID-19 patients, and the interruption of educational activities and trainees’ assessments. There is some consensus on the suggested solutions for mitigation of the interruption in fellowship training.

COVID-19 and Standardized Vaccines Development: A Brief Review

The severe acute respiratory syndrome coronavirus disease (COVID-19) pandemic brings a global emergency affecting all civilizations. After the initial spread from Wuhan City atypical form of pneumonia to other areas of the world led the world health organization to look after it as a pandemic situation. The clinical coronavirus now spread all over the globe and brutally affected almost all countries including community transmission. The current capital of coronavirus cases in the US, trailed by India and Brazil, respectively. The most common symptoms were mild to moderate respiratory discomfort. Lung was the main targeting organ for COVID-19 infection resulting in severe pneumonia. Furthermore, severe acute respiratory distress syndrome (ARDS), acute cardiac injury, along with pathological features such as RNAaemia with shared ground-glass opacities that may be a cause for death in patients. The surface glycoproteins may be responsible for this garnishing of the virus belonging to the Coronaviridae family. Vaccines work to enhance the immune system of the body by training and making it ready to fight a specific pathogenic agent. At present there over 50 COVID-19 vaccine candidates are in trials, some of which are now ready to deliver via emergency use authorization (EUA). The vast majority of viral vaccines currently licensed for humans can be categorized as inactivated or live-attenuated viruses and protein-based subunit vaccines. Hence, we hereby review the significance of certain genotypic vaccines that are currently subjected for development such as non-replicating viral vectors, mRNA vaccine, self-amplifying mRNA vaccine, DNA vaccine, whole-virus inactivated vaccine, and a subunit vaccine. The current review also explores the mode of pathogenesis and invasion of COVID-19 virus to host cell that would be well-comprised data for future studies in the concerned area of interest.

Severe Acute Respiratory Syndrome Coronavirus 2 Convalescent Plasma Versus Standard Plasma in Coronavirus Disease 2019 Infected Hospitalized Patients in New York: A Double-Blind Randomized Trial.

Four peer-reviewed publications have reported results from randomized controlled trials of convalescent plasma for coronavirus disease 2019 infection; none were conducted in the United States nor used standard plasma as a comparator. To determine if administration of convalescent plasma to patients with coronavirus disease 2019 increases antibodies to severe acute respiratory syndrome coronavirus 2 and improves outcome. Double-blind randomized controlled trial. Hospital in New York. Patients with polymerase chain reaction documented coronavirus disease 2019 infection. Patients were randomized (4:1) to receive 2 U of convalescent plasma versus standard plasma. Antibodies to severe acute respiratory syndrome coronavirus 2 were measured in plasma units and in trial recipients. Enrollment was terminated after emergency use authorization was granted for convalescent plasma. Seventy-four patients were randomized. At baseline, mean (sd) Acute Physiology and Chronic Health Evaluation II score (23.4 [5.6] and 22.5 [6.6]), percent of patients intubated (19% and 20%), and median (interquartile range) days from symptom onset to randomization of 9 (6-18) and 9 (6-15), were similar in the convalescent plasma versus standard plasma arms, respectively. Convalescent plasma had high neutralizing activity (median [interquartile range] titer 1:526 [1:359-1:786]) and its administration increased antibodies to severe acute respiratory syndrome coronavirus 2 by 14.4%, whereas standard plasma administration led to an 8.6% decrease (p = 0.005). No difference was observed for ventilator-free days through 28 days (primary study endpoint): median (interquartile range) of 28 (2-28) versus 28 (0-28; p = 0.86) for the convalescent plasma and standard plasma groups, respectively. A greater than or equal to 2 point improvement in the World Health Organization scale was achieved by 20% of subjects in both arms (p = 0.99). All-cause mortality through 90 days was numerically lower in the convalescent plasma versus standard plasma groups (27% vs 33%; p = 0.63) but did not achieve statistical significance. A key prespecified subgroup analysis of time to death in patients who were intubated at baseline was statistically significant; however, sample size numbers were small. Administration of convalescent plasma to hospitalized patients with coronavirus disease 2019 infection increased antibodies to severe acute respiratory syndrome coronavirus disease 2 but was not associated with improved outcome.

The Design of Convergence Curriculum, the Historical Case of Medical Mission and the Research Initiative Outcome of Medicine and Theology

This study focuses on the vulnerability of our society and environment under the Covid-19 pandemic. The medical descriptions about severe acute respiratory syndrome coronavirus disease 2019 provide the serious manifestation of the SARS-CoV-2 virus and a new resilient hope of its vaccination. Moreover, with the perspective of feminist practical theology, the author explores a resilient possibility to reconstitute an ecological relationship between our society and environment. In addition, many people’s depression in the time of Covid-19 is understood in the meaningful narrative of the relationship between integrity and despair to be stressed by Erikson in the perspective of Loder. Especially, this study focuses on the main stream of designing the convergence curriculum of medicine and theology to move toward the life wellbeing of community members, overcoming their difficult circumstances such as Covid-19.

New Methodologies for Conducting Maternal, Infant, and Child Nutrition Research in the Era of COVID-19.

The severe acute respiratory syndrome coronavirus disease 2019 (COVID-19) outbreak rapidly became a worldwide pandemic in early 2020. In Australia, government-mandated restrictions on non-essential face-to-face contact in the healthcare setting have been crucial for limiting opportunities for COVID-19 transmission, but they have severely limited, and even halted, many research activities. Our institute’s research practices in the vulnerable populations of pregnant women and young infants needed to adapt in order to continue without exposing participants, or staff, to an increased risk of exposure to COVID-19. Here, we discuss our pre-and-post COVID-19 methods for conducting research regarding nutrition during pregnancy, infancy, and early childhood. We discuss modifications to study methods implemented to avoid face-to-face contact when identifying and recruiting potential participants, gaining informed consent, conducting appointments, and collecting outcome data, and the implications of these changes. The COVID-19 pandemic has required numerous changes to the conduct of research activities, but many of those modifications will be useful in post-COVID-19 research settings.

The Effects of Using a Clinical Prediction Rule to Prioritize Diagnostic Testing on Transmission and Hospital Burden: A Modeling Example of Early Severe Acute Respiratory Syndrome Coronavirus 2.

BackgroundPrompt identification of infections is critical for slowing the spread of infectious diseases. However, diagnostic testing shortages are common in emerging diseases, low resource settings, and during outbreaks. This forces difficult decisions regarding who receives a test, often without knowing the implications of those decisions on population-level transmission dynamics. Clinical prediction rules (CPRs) are commonly used tools to guide clinical decisions.MethodsUsing early SARS-CoV-2 as an example, we used data from electronic health records to develop a parsimonious 5-variable CPR to identify those who are most likely to test positive. To consider the implications of gains in daily case detection at the population level, we incorporated testing using the CPR into a compartmentalized model of SARS-CoV-2.ResultsWe found that applying this CPR (AUC: 0.69 (95% CI: 0.68 - 0.70)) to prioritize testing increased the proportion of those testing positive in settings of limited testing capacity. We found that prioritized testing led to a delayed and lowered infection peak (i.e., “flattens the curve”), with the greatest impact at lower values of the effective reproductive number (such as with concurrent community mitigation efforts), and when higher proportions of infectious persons seek testing. Additionally, prioritized testing resulted in reductions in overall infections as well as hospital and intensive care unit (ICU) burden.ConclusionWe highlight the population-level benefits of evidence-based allocation of limited diagnostic capacity.

Infected hip prosthesis in patient with suspected Covid-19 infection

BackgroundInfections following arthroplasty are one of the major risks during this type of surgery. Moreover, the outbreak of coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome CoronaVirus Disease 2), has developed into an unprecedented pandemic, posing enormous pressure on health-care providers around the world.Case presentationFour and half years after right hip arthroplasty, the patient came back to our attention with pain at the same hip. The instrumental examinations showed signs of cup detachment. After carefully analyzing the case, we decided to perform a sterile aspiration of the hip in the operating room under C-arm fluoroscopy. Microbiological examinations showed positivity for E. coli. The patient underwent surgery by which the prosthesis was removed and a spacer was implanted. A therapy with Cefotaxim 2 g three times a day for 6 weeks was then set, and then a total arthroplasty was performed. During this period, the COVID-19 pandemic occurred and therefore the patient received nasal-throat swabbing two times, and both yielded negative results. However, 1 week after the final surgery, his respiratory conditions deteriorated and chest X-ray and CT scan showed images of ground-glass opacification patterns (GGO). Due to the clinical symptoms and the characteristic images of the instrumental examinations, the patient was transferred to an observation ward. Thereafter, two more swab tests gave negative results. The patient was then transferred to the ward for patients with typical symptoms of COVID-19 but with negative swab tests for 2 weeks and was subsequently discharged home.ConclusionThe purpose of this case report was to point out the correct treatment of a PJI after the outbreak of COVID-19. Despite the ongoing COVID-19 pandemic, the guidelines in the case of periprosthetic hip infection further confirmed the correct management of the patient.

Hydroxychloroquine in systemic and autoimmune diseases: Where are we now?

Hydroxychloroquine (HCQ), one of the oldest drugs used in rheumatology, came recently into attention as one of the potential therapies tested for the severe acute respiratory syndrome coronavirus-2 disease treatment. Used initially as an antimalarial, then translated to rheumatic diseases, HCQ has been used in a wide range of pathologies, including infectious diseases, immune disorders, diabetes, dyslipidemia, or neoplasia. Regarding systemic diseases, HCQ is the mainstay treatment for systemic lupus erythematosus (SLE), where, according to last European guidelines, it is proposed to all SLE patients unless contraindicated or with side effects. HCQ proved positive impact in SLE on robust outcomes, such as accrual damage, disease activity and survival, but also pleiomorphic effects, including decrease in the need for glucocorticoids, reduction in the risk of neonatal lupus, lower fasting glucose and protection against diabetes, thrombotic risk, dyslipidemia, infections, etc. Moreover, HCQ can be used during pregnancy and breast-feeding. Besides SLE, the role for HCQ in the anti-phospholipid syndrome and Sjögren's disease is still under debate. On the contrary, recent advances showed only limited interest for rheumatoid arthritis, especially due the lack of structural damage prevention. There are still no strong data to sustain the HCQ use in other systemic diseases. In this review, we summarised the utility and efficacy of HCQ in different clinical conditions relevant for rheumatology practice.