Negative RT-PCR Test Research Articles

Long Term Health Problems and Associated Factors among COVID-19 Recovered Patients

A cross-sectional, descriptive study was conducted among 181 individuals recovered from COVID-19 infection and had been missing infection (negative rt-PCR test) or signs-symptoms for minimum three months. The study aims determine newly developed health problems in patients, which was conducted at Post-COVID Unit of Anwer Khan Modern Medical College Hospital, Dhaka, Bangladesh, between July 2021 and June 2022. Through convenient sampling, data were collected by face-to-face interview and history of signs/ symptoms during the infection were recorded from reviewing prescription and interview as well by using a semi-structured questionnaire. The mean age of the participants was 39.56±6.92 years and male-female ratio was 1.45:1. The mean monthly family income of the participants was 36,022.09±4130.56 BDT which represents lower middle to middle class family in terms of Bangladesh context. During COVID-19 infection most of the (97%) respondents had fever, and 87%, 79% of the patients had sore throat and cough respectively as common symptoms; in addition, more than one-third (34%) had diarrhea. Several constitutional symptoms also recorded during their course of illness like headache (74%) and malaise (54%). More than one-third (34%) of the respondents required admission in hospital. During the course of infection, 41%, 26% and 31% participants were suffered from mild, moderate and severe form of COVID-19 illness. Most of the respondents developed long term health problems following COVID infection and post-viral fatigue was the most prevalent (85%) among the post COVID individuals and this long-term health problem-post viral fatigue was found to be associated with monthly income and it was statistically significant (p<0.05). Others long term health problems including shortness of breath (74%), loss of memory (38%), difficulty in concentration (41%), loss of hair (30%), fast beating or pounding heart (33%) were also noticed. Insomnia (56%), persistent cough (35%), loss of taste (32%) and change of bowel habit (28%) were other health problems revealed in this study. Association between loss of memory and gender (p<0.0001), diabetes mellitus and severity of COVID-19 (p<0.05), sore throat, cough and severity of COVID-19 (P<0.05) were also found significant. diabetes mellitus (35%), hypertension (34%) and bronchial asthma (24%) were observed to be most common comorbidities. Shortness of breath – one of the post-COVID consequence was found significantly associated with diabetes mellitus and bronchial asthma (p<0.05). Our study found that persistence of various signs and symptoms from COVID-19 infection and newly yield complications in individual who recovered from COVID-19 infection are collectively comprise long term health problems of post-COVID patients. This long-term health problem of post-COVID people is a major public health concern. Fatigue, dyspnea, difficulty to concentrate, memory loss, persistent cough, fast beating or pounding heart, loss of smell, loss of taste, insomnia are the most common long term health problems in COVID-19 recovered people. Long-term follow up may be recommended to understand future consequences of COVID-19 patients and well-being for the post-COVID people. CBMJ 2024 July: vol. 13 no. 02 P: 158-168

Effect of COVID-19 on peripheral and central hearing abilities

BackgroundCOVID-19 has caused various implications on physical and mental health of human beings. It included several symptoms involving the auditory vestibular system. This study aims to investigate the impact of active COVID-19 infection on central and peripheral auditory pathways.MethodTwo groups of subjects were involved in the research: Group I consisted of 45 individuals with no history of COVID-19, while Group II included 41 individuals who were diagnosed with COVID-19 through RT-PCR testing.The audiological battery used in this study included Pure tone audiometry, Digit in Noise test, Dichotic CV test, and Pitch pattern test, all of which were administered online. Testing was conducted in two phases for both groups. Phase 1 testing took place within the first 7 days of a positive RT-PCR result, while Phase 2 testing occurred within a week of a negative RT-PCR test. Additionally, participants completed a questionnaire to provide information on general health conditions and their otological symptoms.ResultsThe results from Phase 1 testing revealed that Group II exhibited statistically lower scores in all the audiological tests compared to Group I (control group). However, during Phase 2 testing, this significant difference was no longer observed between both groups.ConclusionBased on the findings, it can be inferred that the audiological pathway was compromised during the active infection stage of COVID-19. Therefore, this study highlights changes in performance concerning tests that assess the central auditory system during the infection period.Trial registrationSH/IRB/RP/24. Registered 12 January 2021.

Genetic Analysis and Epidemiological Impact of SARS-CoV-2: A Multinational Study of 1000 Samples Using RT-PCR

The ongoing global public health challenge posed by the COVID-19 pandemic necessitates continuous research and surveillance efforts. In this study, we comprehensively analyzed over 1000 COVID-19 RT-PCR tests conducted on a cohort of 1200 patients in Saudi Arabia. Our primary goal was to investigate mutations in specific genes RdRp, N, and E different infection and recovery stages in Saudi patients with SARS-CoV-2. We also extended our analysis to include patients of various nationalities residing in Saudi Arabia, with the overarching objective of assessing these genes as markers for COVID-19 presence and progression. To diagnose and investigate potential genetic variations in COVID-19, we engaged RT-PCR. Our study primarily focused on detecting mutations in the RdRp, N, and E genes in Saudi patients with SARS-CoV-2, as well as individuals from various national residing in Saudi Arabia. This molecular technique provided valuable insights into the virus’s genetic makeup during infection and recovery. In our analysis of 671 positive COVID-19 cases, diverse gene involvement patterns were observed. Specifically, 55.91% had mutations in all three genes (RdRp, N, and E), 62.33% in both N and E genes, and 67.16% in RdRp and N genes. Additionally, 30.75% exhibited mutations exclusively in the RdRp gene, and 51.58% had mutations in the N gene. The N gene, in particular, showed high sensitivity as a marker for identifying active viral circulation. Regarding the temporal dynamics of the disease, the median duration between a positive and a subsequent negative COVID-19 RT-PCR test result was approximately 33.86 days for 44% of cases, 14.31 days for 30%, and 22.67 days for 4%. The insights from this study hold significant implications for managing COVID-19 patients during the ongoing pandemic. The N gene shows promise as a marker for detecting active viral circulation, potentially improving patient care and containment strategies. Establishing a defined positive threshold for diagnostic methods and correlating it with a low risk of infection remains a challenge. Further research is needed to address these complexities and enhance our understanding of COVID-19 epidemiology and diagnostics.

Correlation between Chest Computed Tomography Severity Scores and Age of Adult Patients with Suspected Covid-19 Pneumonia Admitted in Intensive Care Unit of a Tertiary Care Hospital, Bangladesh

In Bangladesh, the second wave of Covid-19 was devastating. Mostly RT-PCR is used to determine the Covid-19 infection. But when test results are delayed, or when there is a clinical suspicion of Covid-19 despite initial negative RT-PCR testing, CT scan of chest was used to detect Covid-19 and Covid-19 severity. This observational cross-sectional study was carried out at Corona dedicated ICU of Bangabandhu Sheikh Mujib Medical College Hospital, Faridpur during February to June, 2021 to observe the HRCT severity score of the patient and its correlation with different ages. A total of 50 patients with clinically suspected Covid-19 cases who were admitted to the Corona dedicated ICU were included in the study. The chest HRCT images of study participants was gathered, CT severity score was calculated by a particular assignment radiologist. Based on this score; Severe disease was mainly seen in the >60 year age group (50%). A significant moderate positive correlation was observed between age and CT chest severity score. With the increasing age the patients were suffering more and being male may increase the risk and put the patient to get admitted in the ICU, and as an alternative of the RT-PCR, CT scan of chest could be useful. Bangabandhu Sheikh Mujib Med. Coll. J. 2023;2(2):77-82

A detailed statistical analysis of the performance of CO-RADS and CT-severity score in the diagnosis of COVID-19 pneumonia compared to RT-PCR test: a prospective cohort study

BackgroundReports from international studies regarding the role of CT scan and RT-PCR test in the diagnosis of coronavirus disease has been a subject of controversy. The purpose of this study was to statistically compare the performance of CT in reporting chest CT scans of coronavirus disease according to Coronavirus Disease Reporting and Data System (CO-RADS) and CT severity score (CTSS) with the performance of RT-PCR test.ResultsThe analyzed CT scans of 144 participants were consistent with CO-RADS 1 (n = 38), CO-RADS 2 (n = 11), CO-RADS 3 (n = 35), CO-RADS 4 (n = 23), and CO-RADS 5 (n = 37). CTSS in CO-RADS 1 was (0.9 ± 4), CO-RADS 2 (4 ± 2), CO-RADS 3 (10.2 ± 2), CO-RADS 4 (14 ± 6) and CO-RADS 5 (19 ± 7). There was direct correlation between CO-RADS groups and CTSS (p < 0.001). The mean total CTSS was 10 ± 9 for the whole study population. Ninety-five CT scans were compatible with CO-RADS 3, 4 or 5 and 49 CT scans were compatible with CO-RADS 1 or 2, with a positive rate of 66% (95% CI 49%, 65%), PPV (55.41%), NPV (45.18%), accuracy (86.8%) and the overall sensitivity (93.18%) and specificity (76.8%) of CT in detecting COVID-19 pneumonia when categorized and analyzed according to CO-RADS and CTSS. Sixty-four patients had positive initial RT-PCR tests and 80 patients had negative initial RT-PCR test, with a positive rate of 44.4% (95% CI 35%, 51%), PPV (41.13%), NPV (59.51%), accuracy (74.3%), sensitivity (64.2%) and specificity (93.9%). The Kappa (κ) value of average inter-reader agreement was 88% (95% CI 80%, 96%).ConclusionsRT-PCR test showed higher specificity and NPV compared to CT in detecting COVID-19 pneumonia, while CT showed higher sensitivity, PPV, accuracy and positive rate, respectively. CT was superior to RT-PCR test in detecting COVID-19 pneumonia especially at early stages of the disease.

Early Trends to Show the Efficacy of Cordyceps militaris in Mild to Moderate COVID Inflammation.

Background/objective Cordyceps enhances animal survival against influenza by boosting the immune system. In animal studies, it also had anti-inflammatory and preventive properties. Cordyceps stimulates the immune system by increasing the activity and production of various immune cells. Some studies have shown the role of Cordyceps in the novel SARS-CoV-2 virus responsible for the COVID-19 pandemic, in addition to other respiratory diseases caused by the Picorna viruses, SARS-CoV, MERS-CoV, and Influenza viruses. However, it remains unknown whether this food supplement is safe and has anti-inflammatory effects in patients with COVID-19. Therefore, the objectives of this study were to evaluate the use and efficacy of Cordyceps capsules as an adjunct to standard treatment in patients with mild (symptomatic) to moderate COVID-19 infection. Methods A randomised, double-blind, placebo-controlled study was conducted to evaluate the efficacy and safety of Cordyceps capsules (a food supplement) 500 mg as adjuvant therapy in patients with COVID-19. The rationale for dose selection was as per the existing evidence from toxicity studies. The inclusion criteria were patients with either a mild or moderate COVID-19 infection. Clinical features suggestive of dyspnoea or hypoxia, fever, and cough, including SpO2 <94% (range 90-94%) on room air and a respiratory rate ≥24 per minute, were also included. Results Sixty-five patients were recruited for the study, with 33 in the Cordyceps group and 32 in the placebo group. Out of 58 evaluable patients, 33 recovered on day 5, 49 on day 10, and 58 on days 16 and 30. The recovery of patients steadily increased from 56.9% on day 5 to 100% on day 30. The time to clinical recovery was shorter in the Cordyceps group than in the placebo group (mean 6.6 vs. 7.3 days; p > 0.05) overall and for mild disease. However, there was no difference in the time to recovery (time from day 1 to the resolution of all symptoms) for moderate disease. A lower frequency of normal chest X-rays on day 1 and a higher number on day 16 in the treatment group than in the placebo group suggest an improvement in the number of normal chest X-rays with Cordyceps. Significant changes were seen in biomarkers MCPIP, CxCL10, and IL-1β for overall (both mild and moderate patients) on days 5 and 10 as compared to baseline, and in biomarkers CRP and CxCL10 in moderate category patients on days 5 and 10, respectively. There were no statistically significant changes in IL-6, ferritin, lactate dehydrogenase (LDH), C-reactive protein (CRP), or D-dimer levels between baseline and day 5/10 in patients taking Cordyceps capsules and also between the treatment and placebo groups. Conclusion Cordyceps capsules administered at a dose of 500 mg three times a day along with supportive treatment showed effectiveness in patients with mild to moderate COVID-19 infection, as evidenced by the proportionately higher number of recoveries on day 5, the relatively shorter time for improvement of clinical symptoms, and the proportionately higher number of patients showing negative RT-PCR tests on day 10. Thus, Cordyceps appears to be a safe immunological adjuvant for the treatment of patients with mild-to-moderate COVID-19. Future studies with a larger sample size would shed more light on the evidence, as there are limitations in the generalizability of the results from the present study due to the small sample size.

Clinical utility of SARS-CoV-2 subgenomic RT-PCR in a pediatric quaternary care setting.

During active transcription, SARS-CoV-2 generates subgenomic regions of viral RNA. While standard SARS-CoV-2 RT-PCR amplifies region(s) of genomic RNA, it cannot distinguish active infection from remnant viral genomic material. However, screening for subgenomic RNA (sgRNA) by RT-PCR may aid in the determination of actively transcribing virus. To evaluate the clinical utility of SARS-CoV-2 sgRNA RT-PCR testing in a pediatric population. Retrospective analysis was performed on inpatients from February-September 2022 positive for SARS-CoV-2 by RT-PCR with a concomitant order for sgRNA RT-PCR. Chart abstractions were conducted to determine clinical outcomes, management, and infection prevention and control (IPC) practices. Of 95 SARS-CoV-2 positive samples from 75 unique patients, 27 (28.4%) were positive by sgRNA RT-PCR. A negative sgRNA RT-PCR test allowed for de-isolation in 68 (71.6%) patient episodes. Regardless of age or sex, a positive sgRNA RT-PCR result significantly correlated with disease severity (P=0.007), generalized COVID-19 symptoms (P=0.012), hospitalization for COVID-19 (P=0.019), and immune status (P=0.024). Moreover, sgRNA RT-PCR results prompted changes in management in 28 patients (37.3%); specifically, therapeutic escalation in 13/27 (48.1%) positives and de-escalation in 15/68 (22.1%) negatives. Taken together, these findings underscore the clinical utility of sgRNA RT-PCR testing in a pediatric population as we report significant associations between sgRNA RT-PCR results and clinical parameters related to COVID-19. These findings align with the proposed use of sgRNA RT-PCR testing to guide patient management and IPC practices in the hospital setting.

Long term sequelae after SARS-CoV-2 infection in children: a household study

BackgroundIn children persistent symptoms after SARS-CoV-2 infection have been reported, however, duration and characteristics of symptoms in previously healthy children remain unclear. Therefore this study aimed to evaluate persisting symptoms in children at 6 and 12 months after a SARS-CoV-2 infection.MethodsIn this prospective cohort study households with a confirmed SARS-CoV-2 positive outbreak were matched 1:1 to household controls from SARS-CoV-2 negative outbreaks. These households completed questionnaires at 6 and 12 months on the presence and severity of SARS-CoV-2 related symptoms, general well-being/functioning, cognition, persisting symptoms and quality of life.FindingsNone of the children who had a SARS-CoV-2 infection during the study reported persistent symptoms at 6 and 12 months after infection, whereas almost 8% of the children with a negative RT-PCR test during the study reported symptoms such as coughing and mild fever, however, no significant differences were found. In addition, for all other outcomes, no differences were observed between the two groups.Take home messagePost-acute sequelae of mild SARS-CoV-2 infections appears to be uncommon in previously healthy children.

Outcome and Severity of COVID-19 in Vaccinated and Unvaccinated patients

Background: The coronavirus disease of 2019 (COVID-19) pandemic is the world's worst problem and the global health disaster of our time. In order to fully comprehend the advantages of COVID-19 immunization, illness attenuation must be considered. This should be done by investigating whether those who contract COVID-19 despite vaccination experience milder symptoms than those who are unvaccinated. The COVID-19 pandemic brought on by is still a serious public health issue on a global scale. Aim: To evaluate the significant impact and efficacy of vaccination in positive SARS-CoV-2 patients during different timelines of a pandemic. Methodology: This is a cross sectional study involving 212 PCR-positive SARS-CoV-2 patients with their clinical–epidemiological findings admitted at Ziauddin Hospital between the years 2021 to 2022. SARS-CoV-2. RNA positivity was determined using qualitative RT-PCR with in vitro diagnostic kits, following the manufacturer's recommendations. SARS-CoV-2 positive patients had at least one positive RT-PCR test result, while SARS-CoV-2 negative patients had solely negative RT-PCR test findings. The data was provided through electronic patient records. The patients were categorized into Asymptomatic, Mild, Moderate and Severe/Critical as per WHO and CDC guidelines. Results: Among total of 212 patients there were 5(2.4%) vaccinated and 20(9.4%) unvaccinated asymptomatic, 6(2.8%) vaccinated and 12(5.7%) unvaccinated mild, 16(7.5%) vaccinated and 39(18.4%) unvaccinated moderate and 27(12.7%) vaccinated and 87(41%) unvaccinated severely/critically ill patients. The association between the severity of illness and vaccination status of patients showed significantly positive results with a p-value of 0.005. Conclusion: It was concluded that vaccine plays a significant role in the course of illness and severity of disease, this study investigated the impact of vaccination status on patients with positive SARS-CoV-2 to compare the severity and course of illness between the vaccinated and unvaccinated groups based on a number of clinical indicators. but the efficacy of these vaccines remains a point of concern for future studies. Key words: COVID-19, pneumonia, SARS-CoV-2, immunization

Design of a rapid electrochemical biosensor based on MXene/Pt/C nanocomposite and DNA/RNA hybridization for the detection of COVID-19

Since the rapid spread of the SARS-CoV-2 (2019), the need for early diagnostic techniques to control this pandemic has been highlighted. Diagnostic methods based on virus replication, such as RT-PCR, are exceedingly time-consuming and expensive. As a result, a rapid and accurate electrochemical test which is both available and cost-effective was designed in this study. MXene nanosheets (Ti3C2Tx) and carbon platinum (Pt/C) were employed to amplify the signal of this biosensor upon hybridization reaction of the DNA probe and the virus's specific oligonucleotide target in the RdRp gene region. By the differential pulse voltammetry (DPV) technique, the calibration curve was obtained for the target with varying concentrations ranging from 1 aM to 100 nM. Due to the increase in the concentration of the oligonucleotide target, the signal of DPV increased with a positive slope and a correlation coefficient of 0.9977. Therefore, at least a limit of detection (LOD) was obtained 0.4 aM. Furthermore, the specificity and sensitivity of the sensors were evaluated with 192 clinical samples with positive and negative RT-PCR tests, which revealed 100% accuracy and sensitivity, 97.87% specificity and limit of quantification (LOQ) of 60 copies/mL. Besides, various matrices such as saliva, nasopharyngeal swabs, and serum were assessed for detecting SARS-CoV-2 infection by the developed biosensor, indicating that this biosensor has the potential to be used for rapid Covid-19 test detection.

Auditory function in symptomatic patients recovered from SARS-CoV-2 and unexposed patients: An analytical cross-sectional study

ObjectiveTo describe audiological symptoms, audiometric profile, and distortion product otoacoustic emission in symptomatic patients recovering from SARS-CoV-2 infection (positive RT-PCR test) and asymptomatic patients (negative RT-PCR test). MethodsAn analytical cross-sectional study was conducted using data obtained from clinical charts, physical examination, audiometry, and distortion product otoacoustic emission on 40 patients [case patients (CP)] recovering from SARS-CoV-2 infection diagnosed by a positive RT-PCR test and 22 asymptomatic participants with a negative RT-PCR test [non-case (NC)]. ResultsSixty-two patients (mean age: 31.1 and 28.2 years in the CP and NC groups, respectively) were included. All participants were young without significant comorbidities, risk factors for hearing loss or otological history. Vertigo (5%), tinnitus (17.5%) and aural fullness/hearing loss (35%) were found in the CP group. A statistically significant difference was found in specific frequencies (1000, 4000, and 8000 Hz) and pure tone average (low and high conversational frequencies with increased threshold in the PC group compared with the NC group), which was not found in distortion product otoacoustic emission. ConclusionAudiovestibular symptoms are frequent in symptomatic patients recovering from SARS-CoV-2 infection. SARS-CoV-2 infection was consistently associated with an increased audiometric hearing threshold at specific frequencies and low tone average.

Protection of hybrid immunity against SARS-CoV-2 reinfection and severe COVID-19 during periods of Omicron variant predominance in Mexico.

With the widespread transmission of the Omicron SARS-CoV-2 variant, reinfections have become increasingly common. Here, we explored the role of immunity, primary infection severity, and variant predominance in the risk of reinfection and severe COVID-19 during Omicron predominance in Mexico. We analyzed reinfections in Mexico in individuals with a primary infection separated by at least 90 days from reinfection using a national surveillance registry of SARS-CoV-2 cases from March 3rd, 2020, to August 13th, 2022. Immunity-generating events included primary infection, partial or complete vaccination, and booster vaccines. Reinfections were matched by age and sex with controls with primary SARS-CoV-2 infection and negative RT-PCR or antigen test at least 90 days after primary infection to explore reinfection and severe disease risk factors. We also compared the protective efficacy of heterologous and homologous vaccine boosters against reinfection. We detected 231,202 SARS-CoV-2 reinfections in Mexico, most occurring in unvaccinated individuals (41.55%). Over 207,623 reinfections occurred during periods of Omicron (89.8%), BA.1 (36.74%), and BA.5 (33.67%) subvariant predominance and a case-fatality rate of 0.22%. Vaccination protected against reinfection, without significant influence of the order of immunity-generating events and provided >90% protection against severe reinfections. Heterologous booster schedules were associated with ~11% and ~ 54% lower risk for reinfection and reinfection-associated severe COVID-19, respectively, modified by time-elapsed since the last immunity-generating event, when compared against complete primary schedules. SARS-CoV-2 reinfections increased during Omicron predominance. Hybrid immunity provides protection against reinfection and associated severe COVID-19, with potential benefit from heterologous booster schedules.

Comparing the Sensitivity and Specificity of Lung CT-scan with RT-PCR for Diagnosis of COVID-19.

The lung is one of the major organs affected by the SARS-CoV-2 virus. Lung CT scan and RT-PCR are the most valuable diagnostic methods in the early diagnosis and management of COVID-19. Due to the possible inconsistency of the false-negative results for the RT-PCR test, in our study, we aimed to evaluate the sensitivity and specificity of lung CT-scan as an accurate diagnostic method of COVID-19. In this cross-sectional study, patients suspected of COVID-19 and referred to Shahid Beheshti Hospital in Qom city from February 26 to April 13, 2020, were enrolled. For a definitive diagnosis of COVID-19, chest CT scan and RT-PCR testing was performed for 644 patients, and both sensitivity and specificity of lung CT scan were evaluated. According to the findings, and comparing to the RT-PCR test as the gold standard, sensitivity, specificity as well as, positive predictive and negative predictive values of lung CT-scan were found as follow; 94.47% (95% CI: 90.73 - 97.02%), 24.71% (95% CI: 20.70 - 29.07%), 40.73% (95% CI: 36.58 - 44.99%), 89.08% (95% CI: 82.4 - 94.05%), respectively. According to the findings, the lung CT scan has a better diagnostic value than RTPCR in symptomatic patients who were referred to the hospital for COVID-19 diagnosis. Performing lung CT-scan in patients with negative RT-PCR tests should be assessed.

Analysis of Optical Coherence Tomography (OCT) and Optical Coherence Tomography Angiography (OCTA) Parameters in Young Adults after SARS-CoV-2 Infection (COVID-19) Compared with Healthy Young Controls.

To compare retinal changes in young adults with previous SARS-CoV-2 infection with healthy young controls using optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). This prospective single-center study was conducted at the University Hospital of Zurich, Zurich, Switzerland. Participants were imaged from May to November 2021 using the SOLIX device (Visionix International SAS, Pont-de-l'Arche, France). We performed 12 mm × 12 mm, 6.4 mm × 6.4 mm, 6 mm × 6 mm and 3 mm × 3 mm OCT and OCTA scans, as well as fundus photography of each participant's eyes. In total, 466 participants were imaged. Of these, 233 were healthy controls with negative RT-PCR tests for SARS-CoV-2, 168 were young adults who had a SARS-CoV-2 infection at least 180 days previously, 19 were participants who had a SARS-CoV-2 infection < 180 days previously, and 46 were participants with asymptomatic SARS-CoV-2 infection (i.e., serologically positive but with no symptoms). Compared with healthy controls, statistically significant differences were found for OCTA recordings of the optic disc for the whole image (WI) and WI capillary vessel density, with both being higher in the SARS-CoV-2 group. Statistically significant results were only observed for selected variables, and in parts, only unilaterally, with relatively large p values (p = 0.02-0.03). Thus, we did not interpret these as clinically significant, leading to the conclusion that young and otherwise healthy individuals (mainly men) seem to recover from mild COVID-19 infections with no ophthalmological residues.

Impact of COVID-19 during pregnancy on placental pathology, maternal and neonatal outcome - A cross-sectional study on anemic term pregnant women from a tertiary care hospital in southern India.

SARS-CoV-2 infection during pregnancy may cause adverse maternal, neonatal and placental outcomes. While tissue hypoxia is often reported in COVID-19 patients, pregnant women with anemia are suspected to be more prone to placental hypoxia-related injuries. This hospital-based cross-sectional study was conducted between August-November 2021, during COVID-19 second wave in India. Term pregnant women (N=212) admitted to hospital for delivery were enrolled consecutively. Since hospital admission mandated negative RT-PCR test for SARS-CoV-2 virus, none had active infection. Data on socio-demography, COVID-19 history, maternal, obstetric, and neonatal outcomes were recorded. Pre-delivery maternal and post-delivery cord blood samples were tested for hematological parameters and SARS-CoV-2 IgG. Placentae were studied for histology. Of 212 women, 122 (58%) were seropositive for SARS-CoV-2 IgG, but none reported COVID-19 history; 134 (63.2%) were anemic. In seropositive women, hemoglobin (p=0.04), total WBC (p=0.009), lymphocytes (p=0.005) and neutrophils (p=0.02) were significantly higher, while ferritin was high, but not significant and neutrophils to lymphocytes (p=0.12) and platelets to lymphocytes ratios (p=0.03) were lower. Neonatal outcomes were similar. All RBC parameters and serum ferritin were significantly lower in anemic mothers but not in cord blood, except RDW that was significantly higher in both, maternal (p=0.007) and cord (p=0.008) blood from seropositive anemic group compared to other groups. Placental histology showed significant increase in villous hypervascularity (p=0.000), dilated villous capillaries (p=0.000), and syncytiotrophoblasts (p=0.02) in seropositive group, typically suggesting placental hypoxia. Maternal anemia was not associated with any histological parameters. Univariate and multivariate logistic regression analyses of placental histopathological adverse outcomes showed strong association with SARS-CoV-2 seropositivity but not with maternal anemia. When adjusted for several covariates, including anemia, SARS-CoV-2 seropositivity emerged as independent risk factor for severe chorangiosis (AOR 8.74, 95% CI 3.51-21.76, p<0.000), dilated blood vessels (AOR 12.74, 95% CI 5.46-29.75, p<0.000), syncytiotrophoblasts (AOR 2.86, 95% CI 1.36-5.99, p=0.005) and villus agglutination (AOR 9.27, 95% CI 3.68-23.32, p<0.000). Asymptomatic COVID-19 during pregnancy seemed to be associated with various abnormal placental histopathologic changes related to placental hypoxia independent of maternal anemia status. Our data supports an independent role of SARS-CoV-2 in causing placental hypoxia in pregnant women.

Effect of the Previous History of the SARS-CoV-2 Infections on Antibody Levels among Sputnik V Vaccinated Healthcare Workers.

Measuring the level of antibodies produced post-vaccination in response to the SARS-CoV-2 spike protein is considered a strategy for estimating the effectiveness of the COVID-19 vaccines. To examine the antibody levels among the healthcare workers in different hospitals in Mashhad, Iran after receiving the second dose of Sputnik V. In this study, we enrolled 230 healthcare workers for evaluating the Gam-COVID-Vac or Sputnik V after the second administration in different hospitals in Mashhad. Antibody levels of spike protein were quantitatively evaluated in a sample of 230 negative RT-PCR tests for the COVID-19 individuals. The analysis has been done based on an immunological assay using enzyme-linked immunosorbent assay (ELISA). The infection history of the subjects and their families was examined through their medical records. Our results demonstrated a significant association between a higher titer of IgG and a previous history of the COVID-19 infection (P<0.001). Moreover, the chance of detecting antibodies titer more than 50 AU/ml was 16.99 in these people which was significantly higher than in people without a history of infection pre-vaccination [%95CI: (7.38,39.12), P<0.001]. This result demonstrates that the efficacy of antibody production is related to the previous history of the SARS-CoV-2 infections. Ongoing monitoring of the level of antibody among vaccinated populations will help evaluating the effect of vaccines on humoral immunity status.

Oral lesions with immunohistochemical evidence of Sars-CoV-2 in swab-negative post-COVID syndrome.

Growing evidence exists about post-COVID condition/syndrome as sequelae of Sars-CoV-2 infection in healed patients, possibly involving the lungs, brain, kidney, cardiovascular and neuromuscular system, as well the persistency of taste dysfunction. Such symptoms develop during or after infection and continue for more than 12 weeks with pathogenesis related to virus persistency but variable by organs or systems. We recently observed six patients recovered from COVID-19 and with negative RT-PCR testing, showing oral mucosa lesions (mainly ulcers) overlapping those occurring in the acute phase, persisting up to 20 days and thus needing a biopsy with histological investigation and spike protein evaluation by immunohistochemistry. We found epithelial ulceration, inflammatory infiltrate, vessels with increased diameter and flattened endothelium but no thrombi formation; also, we found a weak epithelial SARS-CoV-2 positivity limited to the basal/spinosum layers, progressively decreasing toward the periphery, and the intraepithelial lymphomonocytes, endothelium, and perivascular pericytes too. Our findings provide evidence that SARS-CoV-2 can persist, as for other organs/systems, also in the oral epithelium/mucosa after the acute phase and can be responsible for lesions, although by a pathogenetic mechanism that should be better defined but certainly referable as the oral mucosa counterpart of post-COVID syndrome.

Evaluation of Interleukin 6 Levels in Severe COVID-19 Patients

Objectives: Interleukin 6 (IL-6) plays a leading role in the proliferation and differentiation of immune cells. Level of IL-6 is manifestly increased under many inflammatory conditions, including cytokine release syndrome. We evaluated the IL-6 levels of patients who were hospitalized with the diagnosis of COVID-19.&#x0D; Methods: In the study, the test results of 19 cases whose IL-6 levels were measured between March 11, 2020 and May 31, 2020 retrospectively. The inpatients in the covid service (Group 1) and the patients admitted to the Intensive Care Unit (ICU) of our hospital (Group 2) were compared and evaluated. In addition, patients with positive and negative RT-PCR test results were checked for IL-6.&#x0D; Results: While 8 (Group 1) of 19 patients observed in the clinic were transferred to the ICU, 11 patients (Group 2) were observed in the covid service until their discharge. Group 1 IL-6 levels (median 34 pg/mL) and Group 2 IL-6 levels (median 116 pg/mL) were found to be high in both groups (p = 0,099). However, it was found to be significantly higher in patients with positive COVID-19 RT-PCR test (median 90.60 pg/mL) than in negative patients (median 29.90 pg/mL) (p = 0.018).&#x0D; Conclusion: No significant difference in IL-6 levels between the patients who were monitored in the clinic and transferred to the ICU was found in this study. The significant difference between IL-6 levels among COVID-19 RT-PCR positive and negative patients reveals the importance of IL-6 level with regard to tocilizumab treatment in COVID-19 patients in cytokine storm.&#x0D; Keywords: COVID-19, Interleukin 6, Cytokine Storm, Macrophage Activation Syndrome

Long term effectiveness of inactivated vaccine BBIBP-CorV (Vero Cells) against COVID-19 associated severe and critical hospitalization in Morocco.

We provide national estimates of the real-world Vaccine effectiveness (VE) based on nationally available surveillance data. The study aimed to estimate the effectiveness of the inactivated Covid-19 vaccine BBIBP-CorV (Vero Cells) Sinopharm vaccine currently deployed in Morocco against SARS- CoV-2 severe disease/ hospitalization" within 9 months after vaccination. We conducted a test-negative, case-control study among a population aged 18 years or older who were tested by rt-PCR for SARS-CoV-2 infection from February to October 2021 in Morocco. From the national laboratory COVID-19 database; we identified cases who were rt-PCR positive amongst severe and critical COVID-19 cases and controls who had a negative rt-PCR test for SARS-CoV-2. From the national vaccination register (NVR); individuals vaccinated with COVID-19 Vaccine (Vero Cell) and those unvaccinated were identified and included in the study. The linkage between databases was conducted for the study of Vaccination status based on the timing of the vaccine receipt relative to the SARS-CoV-2 rt-PCR test date. For each person, who tested positive for SARS-CoV-2, we identified a propensity score-matched control participant who was tested negative. We estimated vaccine effectiveness against SARS- CoV-2 severe disease/ hospitalization using conditional logistic regression. Among 12884 persons who tested positive and 12885 propensity score-matched control participants, the median age was 62 years, 47.2% of whom were female. As a function of time after vaccination of second dose vaccination, vaccine effectiveness during the first month was 88% (95% CI, 84-91), 87% (95% CI: 83-90) during the second and third month, 75% (95% CI: 67-80) during the fourth month, 61% (95% CI: 54-67) during the fifth month, and 64% (95% CI: 59-69) beyond the sixth month. VE remained high and stable during the first three months in the two-age subgroup. In the fourth month, the VE in the older population aged 60 years and above (64%) was reduced by 20 points compared to VE in the younger population (84%). A Sinopharm vaccine is highly protective against serious SARS-CoV-2 infection under real-world conditions. Protection remained high and stable during the first three months following the second dose and decreases slightly beyond the fourth month especially beyond 60 years.

Retrospective Analysis of Intensive Care Patients Diagnosed with COVID-19 with Computed Tomography and Clinical Features Despite Negative RT-PCR Test

Özet Amaç: COVID-19 tanısında bilgisayarlı tomografi (BT) bulgularının RT-PCR (real-time reverse transcriptase polymerase chain-reactio) testinden daha spesifik olduğu gösterilmiştir. Bu çalışmadaki amacımız SARS-CoV-2 virüsünü RT-PCR ile gösteremediğimiz ancak klinik ve BT bulguları ile COVID-19 tanısı konulan yoğun bakım hastalarının demografik, klinik özelliklerini ve mortalite oranını araştırmaktır Gereç ve Yöntemler: 14 Mart 2020 ile 1 Haziran 2020 tarihleri arasında üçüncü basamak yoğun bakım ünitelerinde tedavi edilen, RT-PCR negatif olduğu halde klinik ve BT bulguları ile COVID-19 tanısı alan 97 hastanın, demografik, klinik özellikleri ve mortalitelerine ilişkin verileri değerlendirdik Bulgular: Hastalarımızın ortalama yaşı 67±15 ve hastaların %67’sini erkekler oluşturmakta idi. Hastalarımızın %82’sinde en az bir komorbidite eşlik etmekteydi ve en fazla görülen komorbidite ise hipertansiyon ve diabetes mellitus (DM) idi. Hastalardaki en yaygın BT bulguları iki taraflı buzlu cam (%61), konsolidasyon (%23), tek taraflı buzlu cam (%11) görünümü idi. Yoğun bakımda tedavi edilen RT-PCR negatif kritik COVID-19 hastalarımızın mekanik ventilasyon ihtiyacı %54, vasopressör kullanımı %43, mortalite oranı %40 idi . Sonuç: Yoğun bakımda tedavi edilen RT-PCR pozitif COVID-19 hastalar gibi RT-PCR negatif olan ve BT, klinik ile COVID-19 hastalığı tanısı alan hastalar şiddetli hastalık ve kötü sonuçlar açısından yüksek risk altındadırlar. BT ile tanı alan hastalar da RT PCR pozitif hastalar gibi değerlendirilmeli, korunma önlemleri alınmalı ve tedavi planı yapılmalıdır.