Diagnosis Of Coronavirus Disease 2019 Research Articles

The evaluation of the relationship between COVID-19 and autoimmune responses with a cross-sectional trial using medical records.

Several previous studies have suggested a link between autoimmune activation and SARS-CoV-2 infection. This study aims to evaluate the excessive immune response via laboratory and radiological findings, treatment options, and previous acute phase reactants in patients with mild and moderate coronavirus disease 2019 (COVID-19) to identify the possible interaction between autoimmune response and SARS-CoV-2 infection. A total of 345 hospitalized patients with a diagnosis of definitive COVID-19 were evaluated retrospectively in terms of their clinical, laboratory, and radiological data, comorbidities, treatment options, and the values of C-reactive protein (CRP) of all patients in the last year before COVID-19 during admission to the hospital for any reason. 162 (47%) of the patients were female and 183 (53%) were male. The mean age was 51.08 ± 15.52 years. Of all patients, 235 (68.1%) had mild disease and 110 (31.9%) had a moderate disease. There was a statistically significant difference between the two groups in terms of age, gender, the values of leukocytes, lymphocytes, and hemoglobin, the levels of AST, LDH, Na, Cl, Ca, CRP, ferritin and fibrinogen, duration of hospitalization, medical treatments as well as the CRP value of the patients in the last year. Male gender, shortness of breath, duration of hospitalization, the value of lymphocytes, and the levels of LDH, CRP, and fibrinogen were independent predictive factors for the severity of COVID-19. The SARS-CoV-2 infection could act as a triggering factor for developing autoimmune and/or autoinflammatory dysregulation in genetically predisposed individuals.

Padua Score and Coagulopathy Parameters on Survival of COVID-19 Patients at Prof Dr. R. D. Kandou General Hospital Manado

BACKGROUND: Coagulopathy in coronavirus disease 2019 (COVID-19) patients causes a prothrombotic state that increases the risk of thromboembolism. The Padua score and coagulopathy parameter including D-dimer values, fibrinogen, prothrombin time (PT), activated partial thromboplastin time (aPTT), and platelet counts are very important parameters to determine risk of thrombosis and mortality in hospitalized COVID-19 patients. AIM: This study aimed to assess the prognosis of COVID-19 patients with Padua score and coagulopathy parameters. METHODS: This retrospective cohort study was conducted in tertiary university hospital, Prof. Dr. R. D. Kandou Hospital Manado, Indonesia from October 2020 to July 2021. Patients admitted with final diagnosis of COVID-19 confirmed with positive reverse transcriptase-polymer chain reaction test were included in the study. The data were refined by excluding the patients under 18 years old and the patients with no blood test results, D-dimer values, fibrinogen values, PT values, aPTT values, and platelet counts. The association of Padua score and coagulopathy parameters with survival of COVID-19 patients was analyzed by multivariate cox regression and Kaplan–Meier analysis. RESULTS: The probability of survival on day 14 in patients with Padua score <4, D-dimer <0.5 mg/dl, PT ≤16 s, aPTT ≤39 s, and platelets >150,000/μL was 100%, 100%, 84.6%, 81.5%, and 81.4%, respectively. COVID-19 survival was influenced by Padua score ≥4 (heart rate [HR] = 4.199; CI 95% 2.221–7.936), D-dimer ≥0.5 mg/L (HR = 4.772; CI 95% 2.244–10.147), PT >16 s (HR = 2.124; CI 95% 1.608–2.805), aPTT >39 s (HR = 1.449; CI 95% 1.080–1.943), and platelet count <150000/μL (HR = 2.056; CI 95% 1.489–2.840). Padua score has the highest probability of mortality compared to the other coagulopathy parameters (p < 0.001; HR = 3.655; CI 95% 1.927–6.932). CONCLUSION: There was an association of Padua score, D-dimer value, PT value, aPTT value, and platelet count on survival of COVID-19 patients. Padua score being the most influential variable on survivals.

Evaluation of the RSNA consensus: is it sufficient for the diagnosis of COVID-19 with CT?

Purpose: Radiological Society of North America (RSNA) Consensus for coronavirus disease 19 (COVID-19) is developed to evaluate the lung involvement on chest computed tomography (CT) and create a common reporting lexicon. Aim of this study is to determine the frequency of CT features in sex and age groups in patients with COVID-19, compare the findings according to the RSNA consensus classifications, and evaluate the compatibility of the classifications and findings.
 Materials and Methods: Chest CT images of 281 patients with COVID-19 were evaluated. Patients were noted in the appropriate RSNA consensus class. The patients’ data were analyzed by group according to age and sex.
 Results: The main findings included ground-glass opacity, consolidation, and air bronchogram. The common involvement patterns were as follows: bilateral, peripheral, and multifocal. The rates for the typical, atypical, and indeterminate classifications, according to the RSNA consensus, were 63.6%, 9.6%, and 27.0%, respectively. Subpleural fibrous streaking was more frequent in males. Air bronchogram, lymphadenopathy, pleural effusion, subpleural fibrous streaking, bilateral involvement, and a typical classification on CT features were more frequent in the ≥ 65-year age group.
 Conclusion: While the typical appearance classification has results consistent with the findings, we think that the classifications specified as indeterminate and atypical appearance do not show sufficient agreement with the findings and revision is needed for correct diagnostic guidance.

Enhanced real-time mass spectrometry breath analysis for the diagnosis of COVID-19.

Although rapid screening for and diagnosis of coronavirus disease 2019 (COVID-19) are still urgently needed, most current testing methods are long, costly or poorly specific. The objective of the present study was to determine whether or not artificial-intelligence-enhanced real-time mass spectrometry breath analysis is a reliable, safe, rapid means of screening ambulatory patients for COVID-19. In two prospective, open, interventional studies in a single university hospital, we used real-time, proton transfer reaction time-of-flight mass spectrometry to perform a metabolomic analysis of exhaled breath from adults requiring screening for COVID-19. Artificial intelligence and machine learning techniques were used to build mathematical models based on breath analysis data either alone or combined with patient metadata. We obtained breath samples from 173 participants, of whom 67 had proven COVID-19. After using machine learning algorithms to process breath analysis data and further enhancing the model using patient metadata, our method was able to differentiate between COVID-19-positive and -negative participants with a sensitivity of 98%, a specificity of 74%, a negative predictive value of 98%, a positive predictive value of 72% and an area under the receiver operating characteristic curve of 0.961. The predictive performance was similar for asymptomatic, weakly symptomatic and symptomatic participants and was not biased by COVID-19 vaccination status. Real-time, noninvasive, artificial-intelligence-enhanced mass spectrometry breath analysis might be a reliable, safe, rapid, cost-effective, high-throughput method for COVID-19 screening.

The triangle relationship between human genome, gut microbiome, and COVID-19: opening of a Pandora's box.

Since the pandemic started, the coronavirus disease 2019 (COVID-19) has spread worldwide. In patients with COVID-19, the gut microbiome (GM) has been supposed to be closely related to the progress of the disease. The gut microbiota composition and human genetic variation are also connected in COVID-19 patients, assuming a triangular relationship between the genome, GM, and COVID-19. Here, we reviewed the recent developments in the study of the relationship between gut microbiota and COVID-19. The keywords "COVID-19," "microbiome," and "genome" were used to search the literature in the PubMed database. We first found that the composition of the GM in COVID-19 patients varies according to the severity of the illness. Most obviously, Candida albicans abnormally increased while the probiotic Bifidobacterium decreased in severe cases of COVID-19. Interestingly, clinical studies have consistently emphasized that the family Lachnospiraceae plays a critical role in patients with COVID-19. Additionally, we have demonstrated the impact of microbiome-related genes on COVID-19. Specially, we focused on angiotensin-converting enzyme 2's dual functions in SARS-CoV-2 infection and gut microbiota alternation. In summary, these studies showed that the diversity of GMs is closely connected to COVID-19. A triangular relationship exists between COVID-19, the human genome, and the gut flora, suggesting that human genetic variations may offer a chance for a precise diagnosis of COVID-19, and the important relationships between genetic makeup and microbiome regulation may affect the therapy of COVID-19.

Analysis between ABO blood group and clinical outcomes in COVID-19 patients and the potential mediating role of ACE2.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become the most common coronavirus that causes large-scale infections worldwide. Currently, several studies have shown that the ABO blood group is associated with coronavirus disease 2019 (COVID-19) infection and some studies have also suggested that the infection of COVID-19 may be closely related to the interaction between angiotensin-converting enzyme 2 (ACE2) and blood group antigens. However, the relationship between blood type to clinical outcome in critically ill patients and the mechanism of action is still unclear. The current study aimed to examine the correlation between blood type distribution and SARS-CoV-2 infection, progression, and prognosis in patients with COVID-19 and the potential mediating role of ACE2. With 234 patients from 5 medical centers and two established cohorts, 137 for the mild cohort and 97 for the critically ill cohort, we found that the blood type A population was more sensitive to SARS-CoV-2, while the blood type distribution was not relevant to acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), and mortality in COVID-19 patients. Further study showed that the serum ACE2 protein level of healthy people with type A was significantly higher than that of other blood groups, and type O was the lowest. The experimental results of spike protein binding to red blood cells also showed that the binding rate of people with type A was the highest, and that of people with type O was the lowest. Our finding indicated that blood type A may be the biological marker for susceptibility to SARS-CoV-2 infection and may be associated with potential mediating of ACE2, but irrelevant to the clinical outcomes including ARDS, AKI, and death. These findings can provide new ideas for clinical diagnosis, treatment, and prevention of COVID-19.

Long-term effect of COVID-19 infection on kidney function among COVID-19 patients followed in post-COVID-19 recovery clinics in British Columbia, Canada.

We investigated the effect of Post-Acute COVID Syndrome or "long-COVID" on kidney function among patients followed in post-COVID recovery clinics (PCRC) in British Columbia, Canada. Long-COVID patients referred to PCRC between July 2020 to April 2022, aged ≥18years who had an estimated glomerular filtration rate (eGFR) value recorded at 3months from the coronavirus disease 2019 (COVID-19) diagnosis (index) date were included. Those requiring renal replacement therapy prior to index date were excluded. Primary outcome was change in eGFR and urine albumin-creatinine ratio (UACR) after COVID-19 infection. The proportion of patients in each of the six eGFR categories (<30, 30-44, 45-59, 60-89, 90-120 and >120mL/min/1.73m2) and three UACR categories (<3, 3-30 and >30mg/mmol) in all of the study time points were calculated. Linear mixed model was used to investigate change in eGFR over time. The study sample included 2212 long-COVID patients. Median age was 56years, 51% were male. Half (∼47%-50%) of the study sample had normal eGFR (≥90mL/min/1.73m2) from COVID-19 diagnosis to 12months post-COVID and <5% of patients had an eGFR <30mL/min/1.73m2. There was an estimated 2.96mL/min/1.73m2 decrease in eGFR within 1year after COVID-19 infection that was equivalent to 3.39% reduction from the baseline. Decline in eGFR was highest in patients hospitalized for COVID-19 (6.72%) followed by diabetic patients (6.15%). More than 40% of patients were at risk of CKD. People with long-COVID experienced a substantial decline in eGFR within 1year from the infection date. The prevalence of proteinuria appeared to be high. Close monitoring of kidney function is prudent among patients with persistent COVID-19 symptoms.

Highly-specific aptamer targeting SARS-CoV-2 S1 protein screened on an automatic integrated microfluidic system for COVID-19 diagnosis

Variants of the severe acute respiratory syndrome coronavirus (SARS-CoV-2) have evolved such that it may be challenging for diagnosis and clinical treatment of the pandemic coronavirus disease-19 (COVID-19). Compared with developed SARS-CoV-2 diagnostic tools recently, aptamers may exhibit some advantages, including high specificity/affinity, longer shelf life (vs. antibodies), and could be easily prepared. Herein an integrated microfluidic system was developed to automatically carry out one novel screening process based on the systematic evolution of ligands by exponential enrichment (SELEX) for screening aptamers specific with SARS-CoV-2. The new screening process started with five rounds of positive selection (with the S1 protein of SARS-CoV-2). In addition, including non-target viruses (influenza A and B), human respiratory tract-related cancer cells (adenocarcinoma human alveolar basal epithelial cells and dysplastic oral keratinocytes), and upper respiratory tract-related infectious bacteria (including methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae), and human saliva were involved to increase the specificity of the screened aptamer during the negative selection. Totally, all 10 rounds could be completed within 20 h. The dissociation constant of the selected aptamer was determined to be 63.0 nM with S1 protein. Limits of detection for Wuhan and Omicron clinical strains were found to be satisfactory for clinical applications (i.e. 4.80 × 101 and 1.95 × 102 copies/mL, respectively). Moreover, the developed aptamer was verified to be capable of capturing inactivated SARS-CoV-2 viruses, eight SARS-CoV-2 pseudo-viruses, and clinical isolates of SARS-CoV-2 viruses. For high-variable emerging viruses, this developed integrated microfluidic system can be used to rapidly select highly-specific aptamers based on the novel SELEX methods to deal with infectious diseases in the future.

1394-P: Risk for Newly Diagnosed Type 2 Diabetes Mellitus after SARS-CoV-2 Infection among Korean Adults—A Nationwide Matched Cohort Study

Background: There is growing evidence that coronavirus disease 2019 (COVID-19) can cause various extrapulmonary sequelae, including diabetes. However, it is unclear whether these effects persist even after 30 days from the date of diagnosis. We investigated the incidence of newly diagnosed type 2 diabetes mellitus (T2DM) during the post-acute phase of COVID-19. Methods: This cohort study used data from the Health Insurance Review and Assessment Service, a representative national healthcare database in Korea. We initially established a cohort of 348,180 people among those diagnosed with COVID-19 without a history of any diabetes between January 2020, and September 2021. Among people with neither a history of any diabetes nor a diagnosis of COVID-19, the control group consisted of sex- and age-matched people with the cohort. We assessed the hazard ratio (HR) of newly diagnosed T2DM in patients with COVID-19 compared to the control adjusted for age, sex, and presence of hypertension and dyslipidemia. Results: In the post-acute phase of COVID-19, patients with COVID-19 had an increased risk of newly diagnosed T2DM than those without COVID-19 (adjusted HR 1.30, 95% CI 1.27-1.33). The adjusted HRs of non-hospitalized, hospitalized, and intensive care unit-admitted patients were 1.14 (95% CI 1.08-1.19), 1.34 (95% CI 1.30-1.38), and 1.78 (95% CI 1.59-1.99), respectively. Conclusion: COVID-19 may increase the risk of developing T2DM beyond the acute period. The higher the severity of COVID-19 in the acute phase, the higher the risk of newly diagnosed T2DM. Therefore, T2DM should be included as a component for managing long COVID. Disclosure J.Choi: None. K.Song: None.

Respiratory, Cardiac, and Neuropsychiatric Manifestations of Postacute Sequelae of Coronavirus Disease 2019 in Lima, Peru.

Few studies have examined the burden of postacute sequelae of coronavirus disease 2019 (COVID-19) (PASC) in low- and middle-income countries. We sought to characterize PASC with self-reported questionnaires and clinical examinations of end-organ function in Lima, Peru. From January to July 2021, we recruited participants at least 8 weeks after COVID-19 diagnosis from a case registry in Lima, Peru. We evaluated participants for PASC with questionnaires, neuropsychiatric evaluations, chest X-ray, spirometry, electrocardiogram, and echocardiogram. We used multivariable models to identify risk factors for PASC. We assessed 989 participants for PASC at a median 4.7 months after diagnosis. Clinically significant respiratory symptoms were reported by 68.3% of participants, particularly those who had been severely ill during acute COVID-19, and were associated with cardiac findings of ventricular hypertrophy or dilation on echocardiogram. Neuropsychiatric questionnaires were consistent with depression in 20.7% and cognitive impairment in 8.0%. Female sex and older age were associated with increased risk of respiratory (adjusted odds ratio [aOR], 2.36 [95% confidence interval {CI}, 1.69-3.31] and aOR, 1.01 [95% CI, 1.00-1.03], respectively) and neuropsychiatric sequelae (aOR, 2.99 [95% CI, 2.16-4.18] and aOR, 1.02 [95% CI, 1.01-1.03], respectively). COVID-19 survivors in Lima, Peru, experienced frequent postacute respiratory symptoms and depression, particularly among older and female participants. Clinical examinations highlighted the need for cardiopulmonary rehabilitation among persons with severe COVID-19; psychosocial support may be required among all COVID-19 survivors.

Effect of Different Antitumor Regimens on Incidence and Severity of Corona Virus Disease 2019 Pneumonia in Lung Cancer Patients: A Single-center Retrospective Study

Studies have shown that the incidence and severity of corona virus disease 2019 (COVID-19) in patients with lung cancer are higher than those in healthy people. At present, the main anti-tumor treatments for lung cancer include surgery, immunotherapy, chemotherapy, radiotherapy, targeted therapy and anti-angiogenesis therapy. While the effects of different anti-tumor treatments on the occurrence and severity of COVID-19 pneumonia are not uniform. Therefore, we aimed to describe clinical characteristics and antitumor therapy of patients with lung cancer and COVID-19 pneumonia, and examined risk factors for severity in this population. From December 1, 2022 to February 15, 2023, a retrospective study was conducted in 217 patients diagnosed with COVID-19 and pathologically confirmed lung cancer in the Jinling Hospital. We collected data about patients' clinical features, antitumor treatment regimen within 6 months, and the diagnosis and treatment of COVID-19. Risk factors for occurrence and severity of COVID-19 pneumonia were identified by univariable and multivariable Logistic regression models. (1) Among the 217 patients included, 51 (23.5%) developed COVID-19 pneumonia, of which 42 (82.4%) were classified as medium and 9 (17.6%) were classified as severe; (2) Univariate and multivariate analysis revealed overweight (OR=2.405, 95%CI: 1.095-5.286) and intrapulmonary focal radiotherapy (OR=2.977, 95%CI: 1.071-8.274) are risk factors for increasing occurrence of COVID-19 pneumonia, while other therapies are not; (3) Chronic obstructive pulmonary disease (COPD) history (OR=7.600, 95%CI: 1.430-40.387) was more likely to develop severe pneumonia and anti-tumor therapies such as intrapulmonary focal radiotherapy, chemotherapy, targeted therapy and immunotherapy did not increase severity. Intrapulmonary focal radiation therapy within 6 months increased the incidence of COVID-19 pneumonia, but did not increase the severity. However, there was no safety concern for chemotherapy, targeted therapy, surgery and immunotherapy.

Ophthalmic Presentations and Manifestations of COVID-19: A Systematic Review of Global Observations.

As the presentations and complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to surface, the ocular manifestations have emerged as an area of interest. Research and reports conveyed the presence of several ophthalmic conditions observed in Coronavirus disease 2019 (COVID-19) patients. These publications documented a range of presentations varying from asymptomatic to serious impairments. The aim of this study is to characterize the ophthalmic pathologies and their frequencies observed due to COVID-19 in patients across different regions of the world. The goal is that the paper assists primary care physicians and healthcare providers. A systematic review of 31 articles published between January 1, 2021to January 13, 2022, explored the presenting ocular symptoms of COVID-19, diagnosis, duration of ophthalmic complications, as well as pre-existing comorbidities. A total of 816 patients, 427 (52.3%) males and 389 (47.7%) females, from various regions of the world were investigated. Studies focusing on patients with a history of ocular pathologies, non-COVID-19 infections, complications associated with the COVID-19 vaccine, and pediatric patients were excluded from this study. Ocular complications were most commonly reported one to two weeks following the initial COVID-19 diagnosis. Analysis suggests that the "red"eye is the most prevalent presenting ophthalmologic symptom, followed by temporary vision loss. Conjunctivitis was also the most common clinical diagnosis reported, followed by neuro-retinal affection in the form of cotton wool spots (n=127 and n=9, respectively). This study summarizes ocular manifestations in COVID-19 patients and serves to help healthcare providers recognize common symptoms and their severity. This may lead to early diagnosis, treatment, and intervention of these manifestations.

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

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

Pulmonary Artery To Ascending Aorta Ratio On Pulmonary Computerized Tomography In Patients With COVID-19 Infection

Background. Majority of patients infected with coronavirus disease 2019 (COVID-19) present with an acute respiratory illness of varying severity. Chest computerized tomography (CT) is one of the important steps in the diagnostic work-up of pulmonary involvement. Cardiovascular complications including pulmonary arterial (PA) abnormalities have been recently emphasized upon. This study aims to evaluate the relationship between severity of pulmonary infection and pulmonary artery/aorta (PA/AA) ratio on chest CT scan. Material and Methods. This cross section study was conducted on 74 patients with confirmed diagnosis of COVID-19 who underwent chest CT scans.. Radiologists assessed every CT examination and graded the extent of pulmonary involvement and severity score obtained. The diameters of PA and aorta were measured and PA/AA ratio was then calculated. Results. Among 74 patients, 28 patients have abnormal PA/AA ration (&gt;1) . Twenty four patients (32.2%) were classified as mild, 39 (52.7%) as moderate and 11 (14.8%) as severe, with statistically significant difference regarding presence of abnormal PA/AA ratio (P&gt; 0.05) specially in patients with severe pulmonary involvement. There was no significant difference regarding gender and age groups. There was no statistically significant relationship between PA/AA ratio and pattern of pulmonary radiological findings. Conclusion. Covid-19 patients with severe pulmonary involvement (higher severity score) tend to have abnormal PA/AA ratio. PA /A ratio could be used as an additional prognostic radiological marker in assessment of Covid-19 infection.

Clinical and immune-related manifestations in patients with COVID-19

In late 2019 a previously unknown infection affected many people in China. The disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified as coronavirus disease 2019 (COVID-19). In a very short period of time, the virus spread worldwide, so on March 11, 2020, the World Health Organization (WHO) declared a pandemic. Various studies have focused on the risk factors and pathogenesis of the virus and have distinguished different phases of the disease (viremic, hyperinflammatory phase and phase of complications) characterized by a wide range of clinical manifestations. Most patients experience mild flu-like symptoms, but severe disease and even death are possible. The main clinical manifestations are of the respiratory system with lung involvement. Damage caused by COVID-19 is observed in various organs and systems (nervous, endocrine, cardiovascular, excretory system, gastrointestinal tract, liver, immune system, eyes, etc.). In some patients, some of the symptoms may persist for weeks or months after the onset of infection (so-called "long COVID", "post-acute COVID-19" and "post-COVID syndrome (PCS)"). Antiphospholipid syndrome, systemic vasculitis, myositis, arthritis, systemic lupus, skin manifestations, hematological involvement, neurological involvement (Guillain-Barre syndrome, transverse myelitis, etc.), optic neuritis, cardiovascular involvement, acute pancreatitis, glomerulonephritis, thyroiditis, anterior uveitis, conjunctivitis, etc. stand out among them. Unfortunately, children are hit hard by COVID-19. In them, the viral load of SARS-CoV-2 is greater than in adults. More than 700 cases of a unique multisystem inflammatory syndrome in children (MIS-C) characterized by clinical and laboratory manifestations similar to Kawasaki disease and toxic shock syndrome have been described. The disease is severe - about 73% require intensive care, and the overall mortality is about 1.7%. Clinical criteria, laboratory parameters, analysis of blood oxygen saturation, imaging studies and RT-PCR (diagnostic gold standard) are used for the diagnosis of COVID-19. In patients with COVID-19, an individualized therapeutic approach is required. Since the beginning of the pandemic, affected countries have tried to flatten the epidemiological curve and avoid overloading health care systems by imposing specific hygiene measures, limiting social contact, wearing a mask, physical distance, travel restrictions, border closures, national lockdowns and mandatory quarantine for the infected and their contacts. In a short period of time, many highly effective vaccines have been developed, most with mild side effects after administration. Unfortunately, more severe reactions are possible after vaccination, but nevertheless the benefit outweighs the risk. This review aims to present the main clinical manifestations in patients with COVID-19 and the possible complications or post-covid syndromes.

Standardization of in-house anti-IgG and IgA ELISAs for the detection of COVID-19.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19). RT-PCR detection of viral RNA represents the gold standard method for diagnosis of COVID-19. However, multiple diagnostic tests are needed for acute disease diagnosis and assessing immunity during the COVID-19 outbreak. Here, we developed in-house anti-RBD IgG and IgA enzyme-linked immunosorbent assays (ELISAs) using a well-defined serum sample panel for screening and identification of human SARS-CoV-2 infection. We found that our in-house anti-SARS-CoV-2 IgG ELISA displayed a 93.5% sensitivity and 98.8% specificity whereas our in-house anti-SARS-CoV-2 IgA ELISA provided assay sensitivity and specificity at 89.5% and 99.4%, respectively. The agreement kappa values of our in-house anti-SARS-CoV-2 IgG and IgA ELISA assays were deemed to be excellent and fair, respectively, when compared to RT-PCR and excellent for both assays when compared to Euroimmun anti-SARS-CoV-2 IgG and IgA ELISAs. These data indicate that our in-house anti-SARS-CoV-2 IgG and IgA ELISAs are compatible performing assays for the detection of SARS-CoV-2 infection.

Diagnostic value and characteristic analysis of serum nucleocapsid antigen in COVID-19 patients.

To date, several types of laboratory tests for coronavirus disease 2019 (COVID-19) diagnosis have been developed. However, the clinical importance of serum severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleocapsid antigen (N-Ag) remains to be fully elucidated. In this study, we sought to investigate the value of serum SARS-CoV-2 N-Ag for COVID-19 diagnosis and to analyze N-Ag characteristics in COVID-19 individuals. Serum samples collected from 215 COVID-19 patients and 65 non-COVID-19 individuals were used to quantitatively detect N-Ag via chemiluminescent immunoassay according to the manufacturer's instructions. The sensitivity and specificity of the N-Ag assay were 64.75% (95% confidence interval (95% CI) [55.94-72.66%]) and 100% (95% CI [93.05-100.00%]), respectively, according to the cut-off value recommended by the manufacturer. The receiver operating characteristic (ROC) curve showed a sensitivity of 100.00% (95% CI [94.42-100.00%]) and a specificity of 71.31% (95% CI [62.73-78.59%]). The positive rates and levels of serum SARS-CoV-2 N-Ag were not related to sex, comorbidity status or disease severity of COVID-19 (all P < 0.001). Compared with RT‒PCR, there was a lower positive rate of serum N-Ag for acute COVID-19 patients (P < 0.001). The positive rate and levels of serum SARS-CoV-2 N-Ag in acute patients were significantly higher than those in convalescent patients (all P < 0.001). In addition, the positive rate of serum SARS-CoV-2 N-Ag in acute COVID-19 patients was higher than that of serum antibodies (IgM, IgG, IgA and neutralizing antibodies (Nab)) against SARS-CoV-2 (all P < 0.001). However, the positive rate of serum SARS-CoV-2 N-Ag in convalescent COVID-19 patients was significantly lower than that of antibodies (all P < 0.001). Serum N-Ag can be used as a biomarker for early COVID-19 diagnosis based on appropriate cut-off values. In addition, our study also demonstrated the relationship between serum N-Ag and clinical characteristics.

Sociodemographic and clinical characteristics of hospital admissions for COVID-19: A retrospective cohort of patients in two hospitals in the south of Brazil

Background: This database aims to present the sociodemographic and clinical profile of a cohort of 799 patients hospitalized with coronavirus disease 2019 (COVID-19) in two hospitals in southern Brazil. Methods: Data were collected, retrospectively, from November 2020 to January 2021, from the medical records of all hospital admissions that occurred from 1 April 2020 to 31 December 2020. The analysis of these data can contribute to the definition of the clinical and sociodemographic profile of patients with COVID-19. Data description: This dataset covers 799 patients hospitalized for COVID-19, characterized by the following sociodemographic variables: sex, age group, race, marital status and paid work. The sex variable was collected as sex assigned at birth from medical records data. Clinical variables included: admission to clinical ward, hospitalization in the Intensive Care Unit, COVID-19 diagnosis, number of times hospitalized due to COVID, hospitalization time in days and risk classification protocol. Other clinical variables include: pulmonary impairment; patients ventilation pattern; high-flow oxygen mask; pulmonary thromboembolism; cardiovascular disease; pulmonary sepsis; influenza exam results. Other health problems: diabetes, systemic arterial hypertension, chronic obstructive pulmonary disease, obesity, tabaco smoking, asthma, chronic kidney disease, overweight, vascular accident, sedentary lifestyle, HIV/AIDS, cancer, Alzheimer's disease, Parkinson's disease. Conclusions: The analysis of these data can contribute to the definition of the clinical and sociodemographic profile of patients with COVID-19. Thus, a great social impact is demonstrated when databases are published. Open data accelerates the research process, facilitates reuse and enriches datasets, in addition to optimizing the application of public resources, that is, enabling more use of the same investment.

A Comprehensive Review of COVID-19 Pathogenesis, Diagnosis, and Management

SARS-CoV-2 has been found to be the leading cause of the outbreak of coronavirus disease 2019 (COVID-19) globally. The disease is triggered by a new form of coronavirus and is characterized by acute respiratory distress syndrome (ARDS) or some primary chills. It was originated from a wet market in Wuhan, China and has engulfed 6.39 million lives globally uptillseptember-2022. Historically, the world has witnessed many noticeable epidemics in the form of, SARS-CoV (2002 to 2003), H1N1 influenza in 2009, and the most recent Middle East Respiratory Syndrome coronavirus (MERS-CoV), which erupted in Saudi Arabia in 2012. Different people get this disease with different symptoms including mild to severe illness. The molecular and cellular basis of SARS-CoV-2 pathogenesis gives us in-depth mechanisms involved. Experimental investigations have elaborated bats as the primary host for viral the transmission behind COVID-19. Moreover, the anatomy of the virus revealed its RNA based on the genome, which makes its therapeutic interventions more challenging. By the involvement of pre-analytic, analytic, and post-analytical strategies, patients with acute or chronic pneumonia can be distinguished as infected or not. Artificial intelligence has embarked significant importance in the course of viral detection based on computer algorithms. Furthermore, chemical or immune-based therapies were examined for finding a permanent solution to this epidemic issue. This review would cover every emerging aspect of pathogenesis, diagnosis, management, and the latest therapeutic interventions in the course of COVID-19 treatment. By giving rapidly evolving knowledge about this virus, readers are urged to update themselves regularly.

COVID-19 Screening Score for Patients without Acute Respiratory Symptoms Undergoing Emergency Medical Procedures in Indonesia.

To rule out coronavirus disease-2019 (COVID-19) in patients scheduled to undergo emergency medical procedures, SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) must be performed. In developing countries, the use of SARS-CoV-2 RT-PCR has been limited by its unavailability and long processing time. Hence, a quick screening score to predict COVID-19 may help healthcare practitioners determine which patients without acute respiratory symptoms can safely undergo an emergency medical procedure. We conducted a cross-sectional study of adult patients without acute respiratory symptoms who were admitted to the emergency department and underwent an emergency medical procedure within 24 hours after admittance. We collected baseline demographic data, COVID-19 screening variables, and SARS-CoV-2 RT-PCR as the gold standard for COVID-19 diagnosis. Bivariate and multivariate analyses were performed, and a scoring system was developed using statistically significant variables from the multivariate analysis. With data from 357 patients, multivariate backward stepwise logistic regression analysis resulted in two significant COVID-19 predictors: the presence of SARS-CoV-2-IgM antibody (adjusted odds ratio [aOR]: 7.02 [95% CI: 1.49-32.96]) and typical chest x-ray (aOR: 23.21 [95% CI: 10.01-53.78]). A scoring system was developed using these predictors with an area under the receiver operating characteristic curve of 0.71 (95% CI: 0.64-0.78). For a cutoff point of ≥ 2, the scoring system showed 42.5% sensitivity and 97.1% specificity but had poor calibration (Hosmer-Lemeshow test P value < 0.001). We believe that the development of this COVID-19 quick screening score may be helpful in a resource-limited clinical setting, but its moderate discrimination and poor calibration hinder its use as a replacement for the SARS-CoV-2 RT-PCR test for COVID-19 screening.