Severe COVID-19 Illness Research Articles

For people with moderate, severe or critical COVID-19 illness, what are the effects of interleukin 1 (IL-1) blocking agents (anakinra or canakinumab)?

For people with moderate, severe or critical COVID-19 illness, what are the effects of interleukin 1 (IL-1) blocking agents (anakinra or canakinumab)?

Health Status, Persistent Symptoms, and Effort Intolerance One Year After Acute COVID-19 Infection.

BackgroundThe long-term prevalence and risk factors for post-acute COVID-19 sequelae (PASC) are not well described and may have important implications for unvaccinated populations and policy makers.ObjectiveTo assess health status, persistent symptoms, and effort tolerance approximately 1 year after COVID-19 infectionDesignRetrospective observational cohort study using surveys and clinical dataParticipantsSurvey respondents who were survivors of acute COVID-19 infection requiring Emergency Department presentation or hospitalization between March 3 and May 15, 2020.Main Measure(s)Self-reported health status, persistent symptoms, and effort toleranceKey ResultsThe 530 respondents (median time between hospital presentation and survey 332 days [IQR 325–344]) had mean age 59.2±16.3 years, 44.5% were female and 70.8% were non-White. Of these, 41.5% reported worse health compared to a year prior, 44.2% reported persistent symptoms, 36.2% reported limitations in lifting/carrying groceries, 35.5% reported limitations climbing one flight of stairs, 38.1% reported limitations bending/kneeling/stooping, and 22.1% reported limitations walking one block. Even those without high-risk comorbid conditions and those seen only in the Emergency Department (but not hospitalized) experienced significant deterioration in health, persistent symptoms, and limitations in effort tolerance. Women (adjusted relative risk ratio [aRRR] 1.26, 95% CI 1.01–1.56), those requiring mechanical ventilation (aRRR 1.48, 1.02–2.14), and people with HIV (aRRR 1.75, 1.14–2.69) were significantly more likely to report persistent symptoms. Age and other risk factors for more severe COVID-19 illness were not associated with increased risk of PASC.ConclusionsPASC may be extraordinarily common 1 year after COVID-19, and these symptoms are sufficiently severe to impact the daily exercise tolerance of patients. PASC symptoms are broadly distributed, are not limited to one specific patient group, and appear to be unrelated to age. These data have implications for vaccine hesitant individuals, policy makers, and physicians managing the emerging longer-term yet unknown impact of the COVID-19 pandemic.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-07379-z.

Characteristics, Vaccination Status and Outcomes Among Healthy Younger Adults in a Large Public Healthcare System in the South Florida Region.

Nationally, the 18–49 years old age group are less likely to be vaccinated compared to those 50 years and older. Data describing the risk of COVID-19 severe illness that requires hospitalization among younger healthy adults is limited. In an effort to underscore the importance of vaccination and provide data that may influence COVID-19 risk perception, COVID-19 data of a sample of hospitalized non-elderly age group who clinically may not be considered as high risk for severe COVID-19 illness are presented. Specifically, this retrospective chart review (spanning the period of March 2020 to September 2021) provides a descriptive analysis examining the characteristics, vaccination status and outcomes of adults who were hospitalized at Memorial Healthcare System with laboratory-confirmed COVID-19. The study’s data focuses on non-pregnant adults, aged 18–49 years old, without underlying conditions and with no reported history of smoking. As a sub-analysis, data on young and otherwise healthy pregnant females who were hospitalized with COVID-19, as well as data stratified by the pre-Delta and Delta variant dominant period are also presented. There was a total of 482 young and otherwise healthy non-pregnant adults who were hospitalized with COVID-19. Overall, more than 13% of our study population had severe COVID-19 disease. Further, a higher proportion of unvaccinated patients had severe COVID-19 compared to those who received at least one dose of the vaccine. All ventilator or ECMO placements, 30-day readmissions and deaths occurred among unvaccinated patients.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10900-022-01062-y.

Severe COVID-19 illness in an Indian adolescent with autoimmune polyendocrinopathy syndrome-1

Autoimmune polyglandular syndrome-1 (APS-1)also known as autoimmune polyendocrinopathy candidiasis ectodermal dystrophy is a rare autosomal recessive disorder caused by mutation of AIRE gene on chromosome 21q22.3 with an overall prevalence of <1:100,000. Here, we present a 16-year-old male having clinical history of evolution of symptoms for oral candidiasis, hypoparathyroidism, and adrenal insufficiency (AI). He developed rare endocrine and non-endocrine manifestations such as type-1 diabetes (T1D) and autoimmune hepatitis, respectively. The patient while on hormone replacement therapy along with immunosuppressants developed liver cirrhosis and portal hypertension with esophageal varices and candidiasis. Subsequently, he was admitted for complaints of cough, cold and fever and was confirmed to be affected by SARS-CoV-2 by reverse transcription-polymerase chain reaction method. In his prolonged ICU stay of 26 days, he required oxygen therapy, intravenous glucocorticoids, remdesivir, low molecular weight heparin, and hemodynamic support with inotropes. His medical management with subcutaneous insulin therapy and azathioprine was continued. He was discharged after complete resolution of symptoms and negative tests for SARS-CoV-2 and was advised radiological and clinical follow-up. Reports suggest that risk of severe COVID does not increase in patients with AI or autoimmunity. However, our patient possibly developed severe COVID not only due to AI and autoimmunity but also associated rare manifestations like hyperglycemia due to T1D and cirrhosis. Thus, good glycemic control and well-tolerated modern immunosuppressant therapy may be useful in improving prognosis of severe COVID-19 illness in patients with APS-1.

Systematic identification of ACE2 expression modulators reveals cardiomyopathy as a risk factor for mortality in COVID-19 patients

BackgroundAngiotensin-converting enzyme 2 (ACE2) is the cell-entry receptor for SARS-CoV-2. It plays critical roles in both the transmission and the pathogenesis of COVID-19. Comprehensive profiling of ACE2 expression patterns could reveal risk factors of severe COVID-19 illness. While the expression of ACE2 in healthy human tissues has been well characterized, it is not known which diseases and drugs might be associated with ACE2 expression.ResultsWe develop GENEVA (GENe Expression Variance Analysis), a semi-automated framework for exploring massive amounts of RNA-seq datasets. We apply GENEVA to 286,650 publicly available RNA-seq samples to identify any previously studied experimental conditions that could be directly or indirectly associated with ACE2 expression. We identify multiple drugs, genetic perturbations, and diseases that are associated with the expression of ACE2, including cardiomyopathy, HNF1A overexpression, and drug treatments with RAD140 and itraconazole. Our joint analysis of seven datasets confirms ACE2 upregulation in all cardiomyopathy categories. Using electronic health records data from 3936 COVID-19 patients, we demonstrate that patients with pre-existing cardiomyopathy have an increased mortality risk than age-matched patients with other cardiovascular conditions. GENEVA is applicable to any genes of interest and is freely accessible at http://genevatool.org.ConclusionsThis study identifies multiple diseases and drugs that are associated with the expression of ACE2. The effect of these conditions should be carefully studied in COVID-19 patients. In particular, our analysis identifies cardiomyopathy patients as a high-risk group, with increased ACE2 expression in the heart and increased mortality after SARS-COV-2 infection.

Dialysis Staff–Reported Impact of COVID-19 on Early Kidney Transplant Steps

COVID-19 has influenced multiple aspects of kidney transplantation, the preferred treatment for most patients with end-stage kidney disease (ESKD). Patients with ESKD and transplant recipients are vulnerable to severe COVID-19 illness given the high prevalence of comorbidities and immunosuppression in these populations.1 Vast disruptions to kidney transplant operations were reported early in the pandemic, with 72% of US transplant centers reporting temporary suspension of living donor kidney transplant activity and 84% of centers reporting some or major restrictions to deceased donor kidney transplants in a national survey in March 2020.

Proportion and risk factors of fatal outcomes among severely and critically ill COVID-19 patients: A hospital experience, Baghdad, Iraq 2021

Background: Severe forms of Coronavirus disease 2019 (COVID‐19) were found among 6 - 10% of all COVID-19 patients. Acute respiratory distress syndrome ARDS is non-cardiogenic pulmonary edema manifested by the rapid development of shortness of breath, tachypnea, and hypoxemia. Patients’ outcomes after critical care for COVID-19 have not been adequately documented in this low-resource environment, despite advocacy for prevention and response measures in low- and middle-income countries. Objectives: To highlight the rate of severe illness among COVID-19 patients and its associated factors in Al-Imam Ali Hospital, Baghdad-Iraq 2021. Patients and Methods: A descriptive cross-sectional study on cases with severe and critical COVID-19 illness (with ARDS) admitted to the isolation ward in Al-Imam Ali Hospital from 23 March to 23 May, 2021. All COVID-19 patients admitted in a severe or critical state were included. A data collection form was filled by the researcher. The P value of < 0.05 was used to determine statistical significance. Ethical Approval was obtained. Results: A total of 504 severely ill COVID-19 patients were included in this study. There were 71 (14.1%) patients below 45 years of age. Males formed 40.9% of patients while that of females was 59.1%. Fever was the presenting symptom in 381 (75.6%) patients, 197 (39.1%) patients had anosmia, and 192 (38.1%) had ageusia. There were 358 (71.0%) survivors while 146 (29.0%) died. Patients aged 65 years or more had more possible risk for death than those below 65 years (OR=1.14, 95% CI =0.6-2.2). Female gender appeared to be protective compared to male gender (OR=0.52, 95% CI =0.35-0.77). Ex-smokers had a higher risk than non-smoker and current smokers (OR for ex-smoker=4.38, 95% CI 2.6-7.5), and (OR for current smoker=1.7, 95% CI 0.98-3). Renal disease was found to be a risk factor leading to death (OR=2.9; 95% CI=1.73-5.1). Diabetes Mellitus, respiratory diseases, and solid cancer showed a high risk for death, [OR=2.3, 95% CI=1.4-4; OR=1.7; 95% CI=1.1-2.9, OR=8, 95% CI=3.3-19 respectively]. Patients with three comorbidities had a higher mortality risk, OR=1.6, 95% CI=1.3-2. Conclusion: This study concluded that mortality of severely and critically ill COVID-19 patients was 29%, and males and older patients were risk factors for death. In addition to; ex-smoker, alcoholic, and patients with baseline comorbidities appeared to be risk factors for mortality. Finally; laboratory tests and Pao2/Fio2 ratio can be used to predict the outcome.

COVID-19 in kidney transplant recipients; an Indian experience

Introduction: Kidney transplant recipients appear to be at high risk for severe COVID-19 illness due to chronic immunosuppression and coexisting conditions. Objectives: We aimed to study the clinical characteristics, laboratory and radiological results, treatment aspects and clinical outcomes of kidney transplant patients with COVID-19. Patient and Methods: Twenty consecutive kidney transplant patients with COVID-19 pneumonia from two tertiary care centers from India were retrospectively studied from July 1 to Oct 31, 2020. Results: Of 20 patients, 18 required admission; mean age was 42.8±9.39 years and 18 out of 20 (90%) were male. Symptom onset to testing time was a mean of 3.05±1.47 days. All patients were on triple immunosuppression. The median time since transplantation to COVID-19 was 3.75 years (IQR 2.37-5.41). Fever, cough and breathlessness were the most common presenting symptoms. Nine out of twenty (45%) had severe COVID-19 while six out of 20 (30%) required intensive care. Twelve (60%) patients had lymphopenia. Additionally mycophenolate was withheld in seventeen out of twenty (85 %) and enoxaparin and intravenous methylprednisolone were administered in all hospitalized patients while remdesivir was prescribed in 16 out of 20 (80%). Moreover, acute kidney injury (AKI) was seen in five out of 20 (25%) since one of died (5%). After a median hospital stay of 8.5 days (IQR 6.75-15.5), seventeen patients were discharged from the hospital. Conclusion: COVID-19 infection in kidney transplant recipients is usually a moderate-severe form. COVID-19 should be a differential diagnosis for fever in this high-risk population however lymphopenia may not be seen in all. Antimetabolite withdrawal, intravenous steroid, anticoagulation and early remdesivir were all found to be safe and effective strategies for improving outcomes. Early diagnosis and timely treatment may decrease mortality in this high-risk population.

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Клинические проявления постковидного синдрома

Aim: to assess the prevalence of various clinical manifestations in COVID-19 survivors, depending on the time interval after the disease, clinical severity, and the presence of polymorbidity. Patients and Methods: the study included 253 patients (187 females and 66 males), 18–85 years old, who survived COVID-19. The patients were split into two groups based on the disease severity during the acute phase: group 1 consisted of patients with mild COVID-19 illness (n=133); group 2 consisted of patients with moderate and severe COVID-19 illness (n=120). In addition, patients of each of the groups were divided into two subgroups, depending on the time elapsed from the acute phase of COVID-19 illness: in subgroups A the health assessment of patients was performed within 3 months (12 weeks) after the acute phase of the diseases and in subgroups B — 3 months (12 weeks) after the disease, i.e. the time interval ranged from 3 months to one year after COVID-19 illness. A multi-stage phone interview of the patients was used to reveal the presence of symptoms. Also, outpatient medical records of those patients who addressed therapists or narrow specialists, were reviewed. Results: symptoms were revealed both in patients of subgroup 1A (45/52 (86.5%)) and subgroup 2А (42/45 (93.3%)), or, in other words, the symptoms were absent in 7 (13.5%) and 3 (6.7%) patients, respectively. Three months after COVID-19 illness, the symptoms were absent in 34 (42%) patients of subgroup 1B and in 13 (17.3%) patients of subgroup 2B (p<0.001), while at least one symptom persisted in 47/81 (58%) patients of subgroup 1B and 62/75 (82%) patients of subgroup 2B. In both patient groups the most common symptoms comprised fatigue, shortness of breath, and cough. In group 2 patients central nervous and cardiovascular system consequences and arthralgia were frequently reported. The prevalence of comorbidities was higher in group 2 patients than that in group 1 patients, and the difference was statistically significant (p < 0.01). Conclusions: the development of post-COVID-19 syndrome does not depend on the illness severity during the acute phase, and it may occur both in mild and moderate or severe cases. However, in the latter category the patients will have more symptoms. In patients recovered from COVID-19, most of the disease sequela were revealed in central nervous, bronchopulmonary, and cardiovascular systems. Comorbidities are associated with the severity of the novel coronavirus disease during the acute phase. COVID-19 survivors need follow-up care during the first three months after the acute phase and in the later period which should be provided by multidisciplinary team of specialists for achieving complete recovery of the patients’ health and improving the quality of life. KEYWORDS: coronavirus infection, COVID-19, post-COVID-19 syndrome, comorbidities, central nervous system disorders, bronchopul - monary system disorders, cardiovascular system disorders. FOR CITATION: Asfandiyarova N.S., Filippov E.V., Demikhov V.G. et al. Clinical manifestations of post-COVID-19 syndrome. Russian Medical Inquiry. 2022;6(11):612–617 (in Russ.). DOI: 10.32364/2587-6821-2022-6-11-612-617.

The Association of Electronic Cigarette Use With SARS-CoV-2 Infection and COVID-19 Disease Severity.

BACKGROUNDAlthough combustible cigarette use is an established risk factor for severe COVID-19 disease, there is conflicting evidence for the association of electronic cigarette use with SARS-CoV-2 infection and COVID-19 disease severity.METHODSStudy participants were from the Kaiser Permanente Research Bank (KPRB), a biorepository that includes adult Kaiser Permanente members from across the United States. Starting in April 2020, electronic surveys were sent to KPRB members to assess the impact of the COVID-19 pandemic. These surveys collected information on self-report of SARS-CoV-2 infection and COVID-related risk factors, including electronic cigarette and combustible cigarette smoking history. We also used electronic health records data to assess COVID-19 diagnoses, positive PCR lab tests, hospitalizations, and death. We used multivariable Cox proportional hazards regression to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) comparing the risk of SARS-CoV-2 infection between individuals by e-cigarette use categories (never, former, and current). Among those with SARS-CoV-2 infection, we used multivariable logistic regression to estimate adjusted odds ratios (ORs) and 95% CIs comparing the odds of hospitalization or death within 30 days of infection between individuals by e-cigarette use categories.RESULTSThere were 126,475 individuals who responded to the survey and completed questions on e-cigarette and combustible cigarette use (48% response rate). Among survey respondents, 819 (1%) currently used e-cigarettes, 3,691 (3%) formerly used e-cigarettes, and 121,965 (96%) had never used e-cigarettes. After adjustment for demographic, behavioral, and clinical factors, there was no association with SARS-CoV-2 infection and former e-cigarette use (hazard ratio (HR) = 0.99; CI: 0.83–1.18) or current e-cigarette use (HR = 1.08; CI: 0.76–1.52). Among those with SARS-CoV-2 infection, there was no association with hospitalization or death within 30 days of infection and former e-cigarette use (odds ratio (OR) = 1.19; CI: 0.59–2.43) or current e-cigarette use (OR = 1.02; CI: 0.22–4.74).CONCLUSIONSOur results suggest that e-cigarette use is not associated with an increased risk of SARS-CoV-2 infection or severe COVID-19 illness.

Clinical Severity on Hospital Admission for COVID-19: An Analysis of Social Determinants of Health From an Early Hot Spot in the Southeastern U.S.

Introduction:Disparities in COVID-19 infection, illness severity, hospitalization, and death are often attributed to age and comorbidities, which fails to recognize the contribution of social, environmental, and financial factors on health. The purpose of this study was to examine relationships between social determinants of health (SDOH) and COVID-19 severity.Methods:This multicenter retrospective study included adult patients hospitalized with COVID-19 in Southwest Georgia, U.S. The primary outcome was the severity of illness among patients on hospital admission for COVID-19. To characterize the effect of biological and genetic factors combined with SDOH on COVID-19, we used a multilevel analysis to examine patient-level and ZIP code-level data to determine the risk of COVID-19 illness severity at admission.Results:Of 392 patients included, 65% presented with moderate or severe COVID-19 compared to 35% with critical disease. Compared to moderate or severe COVID-19, increasing levels of Charlson Comorbidity Index (OR 1.15, 95% CI 1.07-1.24), tobacco use (OR 1.85, 95% CI 1.10-3.11), and unemployment or retired versus employed (OR 1.91, 95% CI 1.04-3.50 and OR 2.17, 95% CI 1.17-4.02, respectively) were associated with increased odds of critical COVID-19 in bivariate models. In the multi-level model, ZIP codes with a higher percentage of Black or African American residents (OR 0.94, 95% CI 0.91-0.97) were associated with decreased odds of critical COVID-19.Conclusion:Differences in SDOH did not lead to significantly higher odds of presenting with severe COVID-19 when accounting for patient-level and ZIP code-level variables.

Neurological Manifestations in a Cohort of Egyptian Patients with COVID-19: A Prospective, Multicenter, Observational Study.

Background: The COVID-19 pandemic has reached over 276 million people globally with 5.3 million deaths as of 22nd December 2021. COVID-19-associated acute and long-term neurological manifestations are well recognized. The exact profile and the timing of neurological events in relation to the onset of infection are worth exploring. The aim of the current body of work was to determine the frequency, pattern, and temporal profile of neurological manifestations in a cohort of Egyptian patients with confirmed COVID-19 infection. Methods: This was a prospective study conducted on 582 hospitalized COVID-19 patients within the first two weeks of the diagnosis of COVID-19 to detect any specific or non-specific neurological events. Results: The patients’ mean (SD) age was 46.74 (17.26) years, and 340 (58.42%) patients were females. The most commonly encountered COVID-19 symptoms were fever (90.72%), cough (82.99%), and fatigue (76.98%). Neurological events (NE) detected in 283 patients (48.63%) and were significantly associated with a severe COVID-19 at the onset (OR: 3.13; 95% CI: 2.18–4.51; p < 0.0001) and with a higher mortality (OR: 2.56; 95% CI: 1.48–5.46; p = 0.019). The most frequently reported NEs were headaches (n = 167) and myalgias (n = 126). Neurological syndromes included stroke (n = 14), encephalitis (n = 12), encephalopathy (n = 11), transverse myelitis (n = 6) and Guillain-Barré syndrome (n = 4). Conclusions: Neurological involvement is common (48.63%) in COVID-19 patients within the first two weeks of the illness. This includes neurological symptoms such as anosmia, headaches, as well as a constellation of neurological syndromes such as stroke, encephalitis, transverse myelitis, and Guillain-Barré syndrome. Severity of acute COVID-19 illness and older age are the main risk factors.

Dynamics of SARS-CoV-2 Antibody Response in a Longitudinal Cohort of Healthcare Workers from India

Introduction: Coronavirus Disease 2019 (COVID-19) pandemic has affected healthcare systems worldwide. Healthcare Workers (HCWs) form one of the most at-risk population groups for acquiring infection. Trend analysis of anti Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) antibody titres in vaccination naïve HCWs will give an insight into the role of natural protective immunity against re-infection. Aim: To understand the dynamics of anti SARS-CoV-2 antibody response and its protective role against re-infection in a cohort of HCWs. Materials and Methods: This observational longitudinal cohort study was conducted in a tertiary care hospital in Gurugram, North India from June to December 2020. The study was approved by the Institutional Ethics Committee. Serum specimens from 230 HCWs were tested for anti-spike protein Immunogloublin G (IgG) antibodies by chemiluminescence immunoassay. The HCWs with positive antibody status and previous Polymerase Chain Reaction (PCR) confirmed infection (n=47) were followed-up over 180 days for serial antibody titres at four visits, each at a gap of 30-45 days. Participants were classified into asymptomatic (n=18), mild (n=17) and moderate (n=12) disease categories based on severity of previous COVID19 illness. SPSS version 22.0 was used for statistical analysis. Intergroup comparison of means was done using Kruskal-Wallis test and chi-square test. p&lt;0.05 was considered statistically significant. Results: Positivity rate for anti SARS-CoV-2 IgG antibodies was 25.7%. Seroconversion rate was 90.74% in HCWs with history of previous Real Time-Polymerase Chain Reaction (RTPCR) confirmed COVID-19 infection. Incidence of infection in seronegative group (n=171) was 12.96 per 10,000 person days while in seropositive group, it was 1.29 per 10,000 person days. Risk ratio for infection (baseline seronegative vs baseline seropositive) was determined to be 8.12 [95% Confidence Interval (CI) 1.068-61.755]. Incidence of PCR confirmed SARSCoV-2 re-infection was inversely associated with antibody titres (p=0.018). Antibody response trend showed a peak in mean titres in the 46-90 days period followed by steep decline till 135 days and a gradual waning till 180 days. Conclusion: Significant postinfection immunity is offered by even low to moderate amounts of antibodies and this occurs regardless of whether a seropositive HCW had previous asymptomatic or symptomatic infection. These findings have significant implications in establishing the protective role of anti-spike protein antibodies against subsequent infection.

The Severity of Breakthrough Infections Post-COVID-19 Vaccination in Healthcare and Public Sector in South India

Background: Despite massive vaccination programs implemented to abate COVID-19, breakthrough infections among the vaccinated individuals continue to be a source of worry. Aims and Objective: Therefore, our study aimed to investigate the severity of breakthrough and nonbreakthrough infections of SARS-CoV-2 post-COVID-19 vaccinations among health-care workers, COVID-19 frontline warriors, and the general population in South India. Materials and Methods: A survey was jointly conducted by Jothydev's Diabetes Research Centre and Sree Gokulam Medical College and Research Foundation (Thiruvananthapuram, Kerala, India), to assess the severity of nonbreakthrough and breakthrough infections of COVID-19 after vaccination, especially among health-care workers across South India. Results: Of the 225 vaccinated individuals who responded to the survey, 89.3% were vaccinated with Covishield, 8.9% were vaccinated with Covaxin, and 1.7% with other vaccines. One hundred and fifty-three respondents to the survey had COVID-19 infections. Of these, 82 (53.6%) COVID-19 infections were observed in the health care workers (partially and fully vaccinated) and other COVID-19 frontline warriors. One hundred and forty-two people who developed COVID-19 were vaccinated with Covishield, in which 55 (38.7%) developed COVID-19 after the first dose and 87 (61.3%) developed it after the second dose of vaccination. In the Covaxin group, six people (60%) were affected with COVID-19 after the first dose and 4 (40%) people after the second dose. Only one person out of the four vaccinated with other vaccines developed a breakthrough infection. 65 (72.9%) of the individuals vaccinated with Covishield and 2 (50%) of the individuals vaccinated with Covaxin, and one from other categories of vaccines had reported breakthrough infections, infections occurring ≥14 days after completing the recommended doses of COVID-19 vaccinations. Preexisting comorbidities in the people vaccinated with Covishield. Breakthrough infections included in people with diabetes (n = 14), diabetes and high blood pressure (n = 9), asthma (n = 2), and other diseases including (lung disease, malignancy, kidney diseases, and combined comorbidities) (n = 11), and one person with diabetes in Covaxin vaccinated with one person with diabetes and high blood pressure in the other vaccines group. Breakthrough infections cases (52.3%) were mild to moderate (44.5%) and did not require hospitalization. Conclusion: The incidence of severe or critical COVID-19 illness remained low in fully vaccinated patients, even among patients with comorbidities. Nevertheless, the public should follow strict COVID-19 preventive measures, regardless of vaccination status, to reduce transmission and exposure among persons who might not have achieved protective immunity after vaccination.

Association of Multisystem Inflammatory Syndrome Temporally Associated with COVID-19 (MIS-C) with Coinfections: A Retrospective Cross Sectional Analytical Study from Northern India

Introduction: Multisystem Inflammatory Response Syndrome in Children (MIS-C) temporally associated with Coronavirus Disease 2019 (COVID-19) is characterized by fever, raised inflammatory markers, multisystem involvement with evidence of COVID-19 infection (positive RT-PCR or serology). It occurs concurrently or after 4-6 weeks of acute COVID infection.It has wide range of clinical presentation ranging from mild asymptomatic infection to severe life-threatening illness. Clinical presentation of MIS-C has considerable overlapping features with other tropical infections. During peak wave of COVID-19, when large proportion of population has been affected by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), contracting other infections during and within four weeks of active COVID-19 is inevitable. Despite of this concern, only few researchers have studied co-infection and they explained a complex interaction between COVID-19 and other infections like tuberculosis and dengue. They demonstrated how one infection augments the severity of other. To the best of our knowledge no pediatric population-based study explained the interaction of acute COVID-19 &amp; MIS-C with other infections so far. Aim: To determine the association of MIS-C with co-infections in SARS-CoV-2 positive children of 1 month to less than 18 years of age. Materials and Methods: A retrospective review of the medical records of pediatric patients with SARS-CoV-2 infection, treated from September 2020 to February 2021, was performed.All the patients who fulfilled World Health Organization (WHO) criteria of MIS-C were included. Detailed demographic, clinical, laboratory parameters and associated co-infections were recorded.The severe and non severe MIS-C groups were compared. Sample ‘t’ test, Wilcoxon test and Chi-squared test were used for statistical analysis. Results: A total of 44 children fulfilled the diagnostic criteria of MIS-C and were included in the study. Out of 44 , 20 children (45.4%) had severe disease and 24 had non severe disease. The mean age of children with severe MIS-C was 7.38±5.39 years, as compared to 4.37±4.61 years in the non severe group (p-value= 0.044). Males were predominantly affected in both the groups (Male: Female =1.22:1 in severe MIS-C and 2.4:1 in non severe MIS-C). The gastrointestinal system was most commonly affected in both groups. Associated co-infection was noted more in severe MIS-C group (11 vs 1 patient in severe vs non severe group, p-value=&lt;0.001). Tuberculosis was found to be associated in three patients, followed by complicated enteric fever, and severe dengue in two patients each. The odds ratio for developing severe MIS-C in the presence of co-infections was 10.5(CI=2.33- 47.27) while in its absence it was 0.10(0.02-0.43). Conclusion: The findings of this study support that concurrent infections in COVID-19 can exacerbate the severity of COVID19 illness and may lead to severe MIS-C.

Anti-SARS-CoV-2 antibody responses in convalescent plasma donors with varying severity of COVID-19 illness

Background/Aim. Plasma containing a high titer of anti-SARS-CoV-2 antibodies, donated from individuals who recovered from COVID-19, has the potential to be used as initial therapy for patients who have been infected (passive immunization). It is a challenge to find suitable donors. The aim of the study was to successively monitor antibody titer in donations and to investigate the correlation between antibody titer and the severity of the clinical manifestations. Methods. The retrospective study was conducted from May 1 to October 31, 2020, at the Blood Transfusion Institute of Vojvodina. Donors had to meet certain criteria for inclusion in the study: proven SARS-CoV-2 infection, detected SARS-CoV-2 antibodies in the serum/plasma, fulfillment of general criteria for performing plasmapheresis, and adequate laboratory findings. Results. During the study, 651 apheresis plasma units were collected and divided into two equal doses. Plasma was donated by 311 COVID- 19 convalescents, including 208 (66.9%) men and 103 (33.1%) women. There were 15 (4.8%) plasma donors with asymptomatic infection, 235 (75. 6%) with a mild form of illness, 45 (14.5%) with a moderate form of illness, 16 (5.1%) with a severe form of illness, and none with a critical form of illness. Anti-SARS-CoV-2 IgG antibodies were present in the plasma of donors for more than 6 months after the disease. Plasma donors with a more severe clinical manifestation of COVID-19 had stable antibody levels for a longer period. However, the Pearson correlation of clinical severity and antibody titer did not confirm a statistically significant correlation between the variables. Conclusion. Anti-SARS-CoV-2 antibodies were present in the sample of recovered patients, plasma donors, for more than 6 months after the disease. Even though no statistically significant correlation was found between the anti-SARS-CoV-2 anti-body titer and the clinical severity of COVID-19, in patients with a more severe clinical manifestations of the disease, stable antibody levels were maintained for a longer period.

A study on the factors influencing the transfer of COVID-19 severe illness patients out of the ICU based on generalized linear mixed effect model.

The clinical data of 76 severe illness patients with novel coronavirus SARS-CoV-2 from July to August, 2020 admitted to the ICU Intensive Care Unit ward in a hospital in Urumqi were collected in the paper. By using the Laplace approximation parameter estimation method based on maximum likelihood estimation, the generalized linear mixed effect model (GLMM) was established to analyze the characteristics of clinical indicators in critical patients, and to screen the main influencing factors of COVID-19 critical patients' inability to be transferred out of the ICU in a short time: age, C-reactive protein, serum creatinine and lactate dehydrogenase.

Virgin Olive Oil, A Rich Source of Functional Bioactive Compounds in the Promotion of Human Health: An Overview

The prevention of pathologies by diet management is an important public health challenge. The Mediterranean diet (Med diet) is considered one of the healthiest dietary patterns. According to current scientific research, this dietary pattern is linked to a decreased prevalence and incidence of various chronic diseases, including cardiovascular disease, diabetes, cancer, and age-related cognitive decline, as well as a lower overall mortality rate. In the Mediterranean diet, a high consumption of Virgin Olive Oil (VOO), fruit, nuts, vegetables, and grains is linked to a decreased incidence of many diseases and a longer life expectancy. According to numerous studies, VOO is the major food responsible for the health and nutritional benefits of the Mediterranean diet. VOO chemical compounds have been shown in vitro and in vivo investigations to have potentially favorable health benefits as a result of their biological activities. VOO composition has been linked to a variety of biological activities, including antioxidant, anti-inflammatory, anti-diabetic, anti-cancer, and antiviral characteristics. As a result, increasing attention is being paid to the composition of VOO and the identification of its biologically active components. Because of their antioxidant, anti-inflammatory, and anti-thrombotic properties, phytochemicals, particularly phenolic compounds, have health-promoting effects, especially on cardiovascular and metabolic illnesses. These characteristics are even more important in light of the COVID-19 severe illness's heightened inflammatory and pro-thrombotic consequences. This overview collects and discusses the scattered data available in the literature concerning VOO compounds of biological interest and highlights their possible mechanisms of action and effects on human health. In vitro studies and in vivo intervention trials were selected and included in the study after conducting literature searches through "PubMed" and "Web of Science." In the majority of investigations, the ability of VOO phytochemicals to prevent the oxidation process at both the initiation and promotion/progression phases of several pathologies has been verified. The health benefits discussed in this article support the prospective health benefits acquired from VOO as a possible candidate in developing pharmaceutical preparations and nutraceutical or functional foods for a variety of pathological disorders. This idea could pave the way for future in vivo research and, eventually, clinical trials. In addition, greater research into the mechanisms of action and efficacy is needed to clarify the real biological potential of VOO phytochemicals on humans by performing intervention studies on populations at high disorder risk.

Relationship of smoking with COVID-19 and its adverse effects

There is a direct relationship between COVID-19 and smoking. This relationship has detrimental consequences for smoking and COVID-19 on body physiology. Smoking causes disc herniation, lungs diseases, heart illness, lipid profile changes, muscle protein synthesis declines, head, neck, and gastric cancers, cerebral inflammation, weight loss and obesity. The smoking habit of pregnant women leads to miscarriage, poor foetal growth, and low lipid and protein levels in breast milk. In males, it also reduces semen ejaculation and seminal vesicle volume. The treatment is based on quitting the smoking. Preventive measures such as a healthy diet and regular exercise can help to mitigate the negative consequences of smoking. In addition, smoking has been recognised as a major factor in COVID-19 transmission. Tobacco smokers are at increased risk of serious COVID-19 infection due to poor lung function, cross-infection, and vulnerable hygiene behaviors. People who have smoked in the past are thought to be more susceptible than non-smokers to have more severe COVID-19 illness symptoms. COVID-19 is more common among smokers than nonsmokers. Current smokers are five times more likely to have influenza infection than non-smokers. Smoking has been identified as one of the risk factors linked to infection and death.