Post Coronavirus Disease 2019 Research Articles

Multisystem Inflammatory Syndrome and Autoimmune Diseases Following COVID-19: Molecular Mechanisms and Therapeutic Opportunities.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), has led to huge concern worldwide. Some SARS-CoV-2 infected patients may experience post–COVID-19 complications such as multisystem inflammatory syndrome, defined by symptoms including fever and elevated inflammatory markers (such as elevation of C reactive protein (CRP), erythrocyte sedimentation rate, fibrinogen, procalcitonin test, D-dimer, ferritin, lactate dehydrogenase or IL-6, presence of neutrophilia, lymphopenia, decreased albumin, and multiple organ dysfunction). Post–COVID-19 complications may also manifest as autoimmune diseases such as Guillain-Barré syndrome and systemic lupus erythematosus. Signaling disorders, increased inflammatory cytokines secretion, corticosteroid use to treat COVID-19 patients, or impaired immune responses are suggested causes of autoimmune diseases in these patients. In this review, we discuss the molecular and pathophysiological mechanisms and therapeutic opportunities for multisystem inflammatory syndrome and autoimmune diseases following SARS-CoV-2 infection with the aim to provide a clear view for health care providers and researchers.

Effect of fever or respiratory symptoms on leaving without being seen during the COVID-19 pandemic in South Korea.

ObjectiveCoronavirus disease 2019 (COVID-19) has notably altered the emergency department isolation protocol, imposing stricter requirements on probable infectious disease patients that enter the department. This has caused adverse effects, such as an increased rate of leave without being seen (LWBS). This study describes the effect of fever/respiratory symptoms as the main cause of isolation regarding LWBS after the COVID-19 pandemic.MethodsWe retrospectively analyzed emergency department visits before (March to July 2019) and after (March to July 2020) the COVID-19 pandemic. Patients were grouped based on existing fever or respiratory symptoms, with the LWBS rate as the primary outcome. Logistic regression analysis was used to identify the risk factors of LWBS. Logistic regression was performed using interaction terminology (fever/respiratory symptom patient [FRP]×post–COVID-19) to determine the interaction between patients with FRPs and the COVID-19 pandemic period.ResultsA total of 60,290 patients were included (34,492 in the pre–COVID-19, and 25,298 in the post–COVID-19 group). The proportion of FRPs decreased significantly after the pandemic (P<0.001), while the LWBS rate in FRPs significantly increased from 2.8% to 19.2% (P<0.001). Both FRPs (odds ratio, 1.76; 95% confidence interval, 1.59–1.84 (P<0.001) and the COVID-19 period (odds ratio, 2.29; 95% confidence interval, 2.15–2.44; P<0.001) were significantly associated with increased LWBS. Additionally, there was a significant interaction between the incidence of LWBS in FRPs and the COVID-19 pandemic period (P<0.001).ConclusionThe LWBS rate has increased in FRPs after the COVID-19 pandemic; additionally, the effect observed was disproportionate compared with that of nonfever/respiratory symptom patients.

Pediatric thyroid abscess: an unusual late complication of COVID-19 infection

&lt;p class="abstract"&gt;Coronavirus disease 2019 (COVID-19) infection in children usually presents as mild infection. There have been several reported papers of thyroid dysfunction in adults suffering from SARS-CoV-2 infection but there hasn’t been any reported case in pediatric population. We report first pediatric case of post COVID-19 thyroid abscess that developed 6 weeks post infection.&lt;/p&gt;

Social and legal nuances in improvement of online health education: based on post COVID-19 experience

The Coronavirus Disease 2019 (COVID-19) epidemic has inflicted ruination on medical education and healthcare institutions all across the world. The illness has the potential to produce life- hanging circumstances, and ergo poses issues for medical education, as educationists must give lectures safely while maintaining the integrity and abidance of the medical education process. As a result, determining the usability of online learning techniques, as well as their viability and suitability for medical scholars, is critical. The intent of this study was to present an overview of the scenario faced by medical scholars during the COVID-19 epidemic, as well as to identify medical scholars' knowledge, attitudes, and habits environing electronic medical education. To reduce the impact of the COVID-19 epidemic on medical education and progression, specific preventives and reforms must be enforced. The moment for change has here, and there should be wide support and excitement for effective druthers, like as online training and virtual clinical practise, to minimise the disturbance. Following these preventives, hands-on experience in a safe environment might be offered. Given the fact that covid-19 has led to economic challenges, there is a need to ensure that there is enough funding towards improving health professionals’ education.

Comparative Study of Antibiotic Resistance Pattern for Gram-positive Bacteria Pre and Post-COVID-19 Pandemic

Background: Antimicrobial resistance (AR) is a universal crisis that requires emergent attention and solution. The coronavirus disease 2019 (COVID-19) has provided a real danger to global health. In a try to surround the spread of COVID-19, a large quantity of antibiotics (AB) has been used. During COVID-19 there are real threats that could affect AB activity and potentiate AR.Patients and Method: The study was done in eleven hospitals in Baghdad taking a time of eight months from 1 November 2019 to 30 June 2020. Seven types of AB discs were utilised; those are amoxicillin-clavulanate, azithromycin, ceftriaxone, gentamicin, levofloxacin, meropenem and vancomycin. In the current study, 1324 samples were isolated and tested to detect AR toward AB pre and post COVID-19 pandemic. The microbial isolates were confirmed by the standard microbiological tests.Results: The study revealed that the main bacterial isolates pre-pandemic were Staphylococcus aureus, whereas post-pandemic isolates were Streptococcus species. The AR of Staphylococcus aureus, Streptococcus pneumonia, and B-hemolytic streptococci to amoxicillin-clavulanate, ceftriaxone, and gentamicin was higher in COVID than non-COVID patients. While the AR was variable for the other four AB (Azithromycin, levofloxacin, meropenem, and Vancomycin).Conclusion: Azithromycin, levofloxacin, vancomycin less resisted than amoxicillin-clavulanate, ceftriaxone, gentamycin by Gram-positive bacteria in COVID patients. Meropenem represents a golden standard AB in treating infections during the pandemic attack.

NETosis and Neutrophil Extracellular Traps in COVID-19: Immunothrombosis and Beyond.

Infection with SARS-CoV-2, the causative agent of the Coronavirus disease 2019 (COVID-19) pandemic, causes respiratory problems and multifaceted organ dysfunction. A crucial mechanism of COVID-19 immunopathy is the recruitment and activation of neutrophils at the infection site, which also predicts disease severity and poor outcomes. The release of neutrophil extracellular traps (NETs), occurring during a regulated form of neutrophil cell death known as NETosis, is a key effector function that mediates harmful effects caused by neutrophils. Abundant NETosis and NET generation have been observed in the neutrophils of many COVID-19 patients, leading to unfavorable coagulopathy and immunothrombosis. Moreover, excessive NETosis and NET generation are now more widely recognized as mediators of additional pathophysiological abnormalities following SARS-CoV-2 infection. In this minireview, we introduce subtypes of NET-producing neutrophils (e.g., low-density granulocytes) and explain the biological importance of NETs and the protein cargos of NETs in COVID-19. In addition, we discuss the mechanisms by which SARS-CoV-2 causes NETosis by upregulating viral processes (e.g., viral entry and replication) as well as host pro-NET mechanisms (e.g., proinflammatory mediator release, platelet activation, and autoantibody production). Furthermore, we provide an update of the main findings of NETosis and NETs in immunothrombosis and other COVID-19-related disorders, such as aberrant immunity, neurological disorders, and post COVID-19 syndromes including lung fibrosis, neurological disorder, tumor progression, and deteriorated chronic illness. Finally, we address potential prospective COVID-19 treatment strategies that target dysregulated NETosis and NET formation via inhibition of NETosis and promotion of NET degradation, respectively.

Psychological Distress Was Still Serious Among Anesthesiologists Under the Post COVID-19 Era.

PurposeThis study aims to evaluate the psychological status and the attitudes toward the novel coronavirus disease 2019 (COVID-19) vaccine among anesthesiologists. We expected to analyze related factors and offer them some strategies to prevent and manage psychological issues under the post COVID-19 era.MethodsBased on the Checklist for Reporting Results of Internet E-Surveys (CHERRIES), an online survey was designed and conducted among anesthesiologists in Shaanxi, China. Participants were asked to complete a validated questionnaire voluntarily. The following tests were performed: Depression, Anxiety and Stress Scale (DASS-21), Primary Care Post-traumatic Stress Disorder Screen (PC-PTSD), and the attitudes toward COVID-19 vaccine.ResultsA total of 795 anesthesiologists completed the survey, the majority of them were female, young and middle-aged, well educated, and married. The prevalence of depression, anxiety, and stress in this sample were 26.5%, 35.5%, and 19.9%, respectively. Longer daily working time, concomitant basic chronic disease, and COVID-19 exposure were extracted as risk factors for the psychological symptoms, while vaccination, elder age, and married status were negatively associated with them. An unsatisfied vaccination rate (71.9%) which might be linked with inadequate awareness and perception of the COVID-19 vaccine was also detected in this study.ConclusionAnesthesiologists are still under rising pressure of psychological symptoms in the post COVID-19 era. It is imperative to afford continuous psychological support to them and ensure their mental health and professional performance.

Abstract No.: ABS0615: Anaesthesia management of bilateral bronchopleural fistula for repair

Background and Aims:Bronchopleural fistula (BPF) poses ventilatory challenges during general anaesthesia (GA). Without repair of large BPF, patient’s condition is unlikely to improve. Hence thoracic surgery in these patient is a challenging task. Coronavirus disease 2019 (COVID-19) pandemic, has caused immense morbidityincluding pulmonary sequelae pulmonary complications such as BPF. Perioperative strategies included to maintaining adequate ventilation and haemodynamics.Methods:We present anaesthesia management of five cases, who developed bilateral significant BPF as post COVID-19 sequelae. Conservative treatment with bilateral ICD did not reduce the BPF leak. Hence, surgical closure of BPF was planned. Maintaining adequate ventilation was challenging task. Regional blocks are considered safer alternative in patients with pulmonary disease. Erector spinae blocks (ESP) was performed. Ventilatory and haemodynamic parameters were measured. Pain score and patient comfort was also recorded.Results:Out of five patients , four patients received ESP block and one patient had haemodynamic instability in intensive care unit so,the patient was operated under GA Table 1. Desaturation during positioning were noted in only one patient. Inotropes to maintain haemodynamics were required in two patients . All patients managed under ESP block were comfortable during intraoperative period.Conclusion:ESP block was found to be a a safer option for perioperative management in BPF repair in these patients of post COVID-19 sequelae .Table 1Perioperative data of patientsESP Block (n=4)GA (n=1)Desaturation (n patients)01Inotropic requirement (n patients)11Duration of Surgery (h)1.5 2Opioid Requirement(µg)200 500 ESP: Erector spinae plane, GA: General anaesthesia

The Role of Nutrients in Prevention, Treatment and Post-Coronavirus Disease-2019 (COVID-19).

SARS-CoV-2 virus, infecting human cells via its spike protein, causes Coronavirus disease 2019 (COVID-19). COVID-19 is characterized by shortness of breath, fever, and pneumonia and is sometimes fatal. Unfortunately, to date, there is still no definite therapy to treat COVID-19. Therefore, the World Health Organization (WHO) approved only supportive care. During the COVID-19 pandemic, the need to maintain a correct intake of nutrients to support very weakened patients in overcoming disease arose. The literature available on nutrient intake for COVID-19 is mainly focused on prevention. However, the safe intake of micro- and/or macro-nutrients can be useful either for preventing infection and supporting the immune response during COVID-19, as well as in the post-acute phase, i.e., “long COVID”, that is sometimes characterized by the onset of various long lasting and disabling symptoms. The aim of this review is to focus on the role of nutrient intake during all the different phases of the disease, including prevention, the acute phase, and finally long COVID.

Molecular Imaging Findings on Acute and Long-Term Effects of COVID-19 on the Brain: A Systematic Review.

Molecular imaging techniques such as PET and SPECT have been used to shed light on how coronavirus disease 2019 (COVID-19) affects the human brain. We provide a systematic review that summarizes the current literature according to 5 predominant topics. First, a few case reports have suggested reversible cortical and subcortical metabolic alterations in rare cases with concomitant para- or postinfectious encephalitis. Second, imaging findings in single patients with the first manifestations of parkinsonism in the context of COVID-19 resemble those in neurodegenerative parkinsonism (loss of nigrostriatal integrity), but scarceness of data and a lack of follow-up preclude further etiologic conclusions (e.g., unmasking/hastening of neurodegeneration vs. infectious or parainfectious parkinsonism). Third, several case reports and a few systematic studies have addressed focal symptoms and lesions, most notably hyposmia. The results have been variable, although some studies found regional hypometabolism of regions related to olfaction (e.g., orbitofrontal and mesiotemporal). Fourth, a case series and systematic studies in inpatients with COVID-19–related encephalopathy (acute to subacute stage) consistently found a frontoparietal-dominant neocortical dysfunction (on imaging and clinically) that proved to be grossly reversible in most cases until 6 mo. Fifth, studies on post–COVID-19 syndrome have provided controversial results. In patients with a high level of self-reported complaints (e.g., fatigue, memory impairment, hyposmia, and dyspnea), some authors found extensive areas of limbic and subcortical hypometabolism, whereas others found no metabolic alterations on PET and only minor cognitive impairments (if any) on neuropsychologic assessment. Furthermore, we provide a critical appraisal of studies with regard to frequent methodologic issues and current pathophysiologic concepts. Finally, we devised possible applications of PET and SPECT in the clinical work-up of diagnostic questions related to COVID-19.

Covid-19 associated mucormycosis

: Corona virus disease-2019 (COVID-19) is associated with various opportunistic, bacterial, and fungal infections. High risk groups include people with diabetes especially diabetic ketoacidosis, solid organ transplantation, long-term systemic corticosteroid use, and iron overload. Many cases of mucormycosis were reported worldwide. Mucormycosis is an invasive fungal infection with high morbidity and mortality. Early diagnosis and treatment with appropriate anti-fungals lead to improved outcomes. The aim of this study is to establish the factors associated with mucormycosis in a COVID-19 setting, like comorbidities and treatment protocols for treatment of COVID-19. The histological patterns and tissue reactions to mucormycosis also were studied. In patients with ongoing COVID-19 infection and in a post COVID-19 scenario, we studied the biopsy findings of mucormycosis in various sites like rhino-orbital, lung, gastric and trachea. Material for this study is from a tertiary care hospital in South India. Patient age ranged from 30 years to 74 years. Mean age of the patients was 51 years. Male to female ratio was 1:1.1. Tissue from sino- nasal mucosa, peri orbital tissue, exenterated eyeball, lung tissue and tissue from rare sites like gastric and tracheal mucosal lesions were also included in this study. Tissue was fixed in 10% buffered formalin. Routine Haematoxylin and Eosin(H&amp;E) stains were done. Gomori’s Methenamine silver (GMS) stains were done on all cases. Tissue was submitted for fungal cultures in all the cases.Total of twenty-three cases were diagnosed as mucormycosis based on the morphology and special stains in this analysis. Histology revealed areas of infarction in all cases with neutrophilic infiltration. Granulomatous reaction was seen in seven cases and melanin pigment was seen in two cases. 100% of patients were diabetics. There was neutrophilia in 100% of cases. Lymphopenia was seen in 85.7%, C-Reactive Protein (CRP) was elevated in 100% of cases.Ferritin was done in 14 patients and D-dimer was done in 17 patients and in all patients, these were elevated. All patients were treated with steroids according to the treatment protocol for COVID-19, Remdesivir was given in 72.7% of cases and second immunomodulator drugs like Tocilizumab in four cases and Baricitinib in one case.Mucormycosis is an emerging problem with COVID-19. It is important to carefully monitor blood glucose levels and take into account underlying medical conditions of patients before initiation of steroid therapy. Early recognition of symptoms and early diagnosis has a better outcome in patients with mucormycosis associated with COVID-19 infection.

Occurrence of De novo Donor-Specific Antibodies After COVID-19 in Kidney Transplant Recipients Is Low Despite Immunosuppression Modulation

IntroductionDecreased immunosuppression has been proposed for kidney transplant recipients infected with coronavirus disease 2019 (COVID-19), but the impact on the alloreactive immune response during and after infection has been poorly investigated. We evaluated the occurrence of antihuman leukocyte antigen (HLA) donor-specific antibodies (DSAs) (post–COVID-19) and rejection episodes after COVID-19 with particular focus on immunosuppression modulation.MethodsKidney transplant recipients from 2 French institutions had anti-HLA antibody screening before and after COVID-19. Management of immunosuppression, rejection episodes, COVID-19 severity, inflammatory markers, and antiviral therapies were recorded.ResultsFrom 251 recruited patients, 72 were excluded because of COVID-19–related death (n = 25) and incomplete immunologic follow-up (n = 47). Among the remaining 179 included patients, almost half were hospitalized (49.2%). Antimetabolites were interrupted in 47% of patients (82% in hospitalized, median time of resumption of 23 days and in 15% nonhospitalized, median time of resumption of 7 days). Calcineurin inhibitors were interrupted in 12% of patients (all hospitalized, median time of resumption of 11 days). The incidence of post–COVID-19 DSA was 4% (8% and 0% in hospitalized and nonhospitalized, respectively). Allograft rejection occurred in 3 patients (1.7%) and all were hospitalized. Younger age, transplantation <1 year, and preexisting DSA were more frequently observed in patients with post–COVID-19 DSA, whereas inflammatory markers, lymphopenia, and use of antiviral therapies were not.ConclusionThe incidence of post–COVID-19 DSA among COVID-19–positive kidney transplant recipients was low (4%) despite a significant decrease in immunosuppression and was mainly restricted to high-risk immunologic patient’s status. COVID-19 severity was not associated with post–COVID-19 DSA and/or rejection.

Spatiotemporal analysis of urban road congestion during and post COVID-19 pandemic in Shanghai, China

Coronavirus Disease 2019 (COVID-19) has become one of the most serious global health crises in decades and tremendously influence the human mobility. Many residents changed their travel behavior during and after the pandemic, especially for a certain percentage of public transport users who chose to drive their owned vehicles. Thus, urban roadway congestion has been getting worse, and the spatiotemporal congestion patterns has changed significantly. Understanding spatiotemporal heterogeneity of urban roadway congestion during and post the pandemic is essential for mobility management. In this study, an analytical framework was proposed to investigate the spatiotemporal heterogeneity of urban roadway congestion in Shanghai, China. First, the matrix of average speed in each traffic analysis zones (TAZs) was calculated to extract spatiotemporal heterogeneity variation features. Second, the heterogenous component of each TAZ was extracted from the overall traffic characteristics using robust principal component analysis (RPCA). Third, clustering analysis was employed to explain the spatiotemporal distribution of heterogeneous traffic characteristics. Finally, fluctuation features of these characteristics were analyzed by iterated cumulative sums of squares (ICSS). The case study results suggested that the urban road traffic state evolution was complicated and varied significantly in different zones and periods during the long-term pandemic. Compared with suburban areas, traffic conditions in city central areas are more susceptible to the pandemic and other events. In some areas, the heterogeneous component shows opposite characteristics on working days and holidays with others. The key time nodes of state change for different areas have commonness and individuality. The proposed analytical framework and empirical results contribute to the policy decision-making of urban road transportation system during and post the COVID-19 pandemic.

What Drives Employees' Innovative Behaviors in Emerging-Market Multinationals? An Integrated Approach.

The coronavirus disease 2019 (COVID-19) pandemic has severely damaged the global industrial supply chain and accelerated the digital transformation of the global economy. In such rapidly changing environments, multinational corporations (MNCs) should encourage employees to be more innovative in various fields than ever before. With the onset of the COVID-19 pandemic, employees have become psychologically anxious, their working conditions have deteriorated, and they are in danger of losing their jobs. In this study, we aim to address the question of whether servant leadership facilitates the innovative behavior of employees working in emerging-market MNCs when servant leadership is adopted within the firms. In addition, we explore the mediating roles of work–life balance and psychological stability perceived by employees, and the moderating role of organizational climate in the relationship between servant leadership and MNC employees' innovative behavior. In doing so, we collected data from a sample of 307 Chinese employees who are employed by five different Chinese MNCs from the Internet, information technology, electronics, and e-commerce industries. Based on a sample of survey data collected from employees of Chinese MNCs, we empirically test these ideas by specifically examining how servant leadership may shape the innovation behavior of employees in these MNCs. The results suggest that servant leadership positively influences employees' innovative behavior, and that the contribution of servant leadership to employees' innovative behavior is mediated by work–life balance and psychological stability as well as moderated by the degree of organizational climate. Moreover, the different organizational climates of these MNC employees are also expected to significantly shape the relationship between servant leadership and employees' innovative behavior. This study enriches our understanding of the importance of servant leadership in driving the innovative behaviors of employees in emerging-market MNCs and provides new insights into the mechanisms through which emerging-market MNCs can motivate their employees to be more innovative in their jobs. Thus, this study contributes to the research on human resource management by offering important implications vis-à-vis how MNCs manage their employees more effectively in addressing and responding to the dramatically changing global landscape in the post COVID-19 era.

Long-term perturbation of the peripheral immune system months after SARS-CoV-2 infection

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly infectious respiratory virus which is responsible for the coronavirus disease 2019 (COVID-19) pandemic. It is increasingly clear that recovered individuals, even those who had mild COVID-19, can suffer from persistent symptoms for many months after infection, a condition referred to as “long COVID”, post-acute sequelae of COVID-19 (PASC), post-acute COVID-19 syndrome, or post COVID-19 condition. However, despite the plethora of research on COVID-19, relatively little is known about the molecular underpinnings of these long-term effects.MethodsWe have undertaken an integrated analysis of immune responses in blood at a transcriptional, cellular, and serological level at 12, 16, and 24 weeks post-infection (wpi) in 69 patients recovering from mild, moderate, severe, or critical COVID-19 in comparison to healthy uninfected controls. Twenty-one of these patients were referred to a long COVID clinic and > 50% reported ongoing symptoms more than 6 months post-infection.ResultsAnti-Spike and anti-RBD IgG responses were largely stable up to 24 wpi and correlated with disease severity. Deep immunophenotyping revealed significant differences in multiple innate (NK cells, LD neutrophils, CXCR3+ monocytes) and adaptive immune populations (T helper, T follicular helper, and regulatory T cells) in convalescent individuals compared to healthy controls, which were most strongly evident at 12 and 16 wpi. RNA sequencing revealed significant perturbations to gene expression in COVID-19 convalescents until at least 6 months post-infection. We also uncovered significant differences in the transcriptome at 24 wpi of convalescents who were referred to a long COVID clinic compared to those who were not.ConclusionsVariation in the rate of recovery from infection at a cellular and transcriptional level may explain the persistence of symptoms associated with long COVID in some individuals.

Clinical significance of micronutrient supplements in patients with coronavirus disease 2019: A comprehensive systematic review and meta-analysis.

Background and aimsMicronutrient supplements such as vitamin D, vitamin C, and zinc have been used in managing viral illnesses. However, the clinical significance of these individual micronutrients in patients with Coronavirus disease 2019 (COVID-19) remains unclear. We conducted this meta-analysis to provide a quantitative assessment of the clinical significance of these individual micronutrients in COVID-19.MethodsWe performed a comprehensive literature search using MEDLINE, Embase, and Cochrane databases through December 5th, 2021. All individual micronutrients reported by ≥ 3 studies and compared with standard-of-care (SOC) were included. The primary outcome was mortality. The secondary outcomes were intubation rate and length of hospital stay (LOS). Pooled risk ratios (RR) and mean difference (MD) with corresponding 95% confidence intervals (CI) were calculated using the random-effects model.ResultsWe identified 26 studies (10 randomized controlled trials and 16 observational studies) involving 5633 COVID-19 patients that compared three individual micronutrient supplements (vitamin C, vitamin D, and zinc) with SOC. Nine studies evaluated vitamin C in 1488 patients (605 in vitamin C and 883 in SOC). Vitamin C supplementation had no significant effect on mortality (RR 1.00, 95% CI 0.62–1.62, P = 1.00), intubation rate (RR 1.77, 95% CI 0.56–5.56, P = 0.33), or LOS (MD 0.64; 95% CI -1.70, 2.99; P = 0.59). Fourteen studies assessed the impact of vitamin D on mortality among 3497 patients (927 in vitamin D and 2570 in SOC). Vitamin D did not reduce mortality (RR 0.75, 95% CI 0.49–1.17, P = 0.21) but reduced intubation rate (RR 0.55, 95% CI 0.32–0.97, P = 0.04) and LOS (MD -1.26; 95% CI -2.27, −0.25; P = 0.01). Subgroup analysis showed that vitamin D supplementation was not associated with a mortality benefit in patients receiving vitamin D pre or post COVID-19 diagnosis. Five studies, including 738 patients, compared zinc intake with SOC (447 in zinc and 291 in SOC). Zinc supplementation was not associated with a significant reduction of mortality (RR 0.79, 95% CI 0.60–1.03, P = 0.08).ConclusionsIndividual micronutrient supplementations, including vitamin C, vitamin D, and zinc, were not associated with a mortality benefit in COVID-19. Vitamin D may be associated with lower intubation rate and shorter LOS, but vitamin C did not reduce intubation rate or LOS. Further research is needed to validate our findings.

Comparison of door-to-balloon time and in-hospital outcomes in patients with ST-elevation myocardial infarction between before versus after COVID-19 pandemic.

The situation around primary percutaneous coronary intervention (PCI) has dramatically changed since coronavirus disease 2019 (COVID-19) pandemic. The impact of COVID-19 pandemic on clinical outcomes as well as door-to-balloon time (DTBT), which is known as one of the indicators of early reperfusion, has not been fully investigated in patients with ST-elevation acute myocardial infarction (STEMI). The purpose of this study was to compare DTBT and in-hospital outcomes in patients with STEMI between before versus after COVID-19 pandemic. The primary interest was DTBT and the incidence of in-hospital outcomes including in-hospital death. We included 330 patients with STEMI who underwent primary PCI, and divided them into the pre COVID-19 group (n = 209) and the post COVID-19 group (n = 121). DTBT was significantly longer in the post COVID-19 group than in the pre COVID-19 group (p < 0.001), whereas the incidence of in-hospital death was comparable between the 2 groups (p = 0.238). In the multivariate logistic regression analysis, chest CT before primary PCI (OR 4.64, 95% CI 2.58–8.34, p < 0.001) was significantly associated with long DTBT, whereas chest CT before primary PCI (OR 0.76, 95% CI 0.29–1.97, p = 0.570) was not associated with in-hospital death after controlling confounding factors. In conclusion, although DTBT was significantly longer after COVID-19 pandemic than before COVID-19 pandemic, in-hospital outcomes were comparable between before versus after COVID-19 pandemic. This study suggests the validity of the screening tests including chest CT for COVID-19 in patients with STEMI who undergo primary PCI.

Twitter Voices: Twitter Users’ Sentiments and Emotions About COVID-19 Vaccination within the United States

Introduction: The Coronavirus Disease 2019 (COVID-19) has negatively impacted society as a whole. Vaccination became the only reliable solution to overcome the severity of this pandemic. A critical factor to achieve an adequate vaccination coverage is by improving public confidence in immunization. Social media plays an important role in reflecting public perception towards certain topics, such as COVID-19 vaccination. This study aims to evaluate U.S. Twitter users’ sentiments and emotions towards COVID-19 vaccination, and the changes experienced before and after vaccine rollout. Methods: COVID-19 vaccine related tweets were collected from Twitter’s Application Programming Interface. We analyzed tweets from March 11, 2020, to May 17, 2021, and divide them into two groups; before and after the first vaccine was implemented in the U.S. Sentiment analysis, negative binomial regression and linear regression models were used for inferential analysis. Results: A total of 19,654 tweets were extracted. From those, 10,374 and 9,280 tweets were posted before and after COVID-19 vaccine was launched in U.S., respectively. A statistically significant difference was evidenced between the two groups when comparing each individual emotion, and positive and negative sentiments, except for joy. Lastly, a statistically significant increase of the sentiment score in the post COVID-19 vaccine group compared to the pre COVID-19 vaccine group was evidenced. Conclusion: Our findings evidenced that public perception of the COVID-19 vaccine has positively changed over time and suggest that the terms “trials” and “vaccination”, which were associated to trust, could potentially be used to create targeted educational and promotional schemes to achieve a better vaccination coverage rate.

Rhino-orbital Fungal Invasion in Post COVID-19 Cases at a Tertiary Eye Care Centre in Hyderabad- A Cross-sectional Study

Introduction: In India, especially in Southern part of the country during the second wave of the pandemic there has been a sudden surge of rhino-orbital invasion by various fungi like Fusarium, Mucor, Aspergillus etc., in post Corona Virus Disease-2019 (COVID-19) patients. Several risk factors have been attributed like lowering of cell-mediated immunity by Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2), lymphopenia and associated reduction in CD4+ (Cluster of Differentiation) and CD8+ cell population, Steroid-induced hyperglycaemia, immunosuppression, and uncontrolled diabetes. Aim: To detect rhino-orbital fungal conquering post COVID-19 cases. Materials and Methods: This was a cross-sectional study done at a tertiary eye care centre in Hyderabad, between May 2021 to June 2021 and the study subjects were post COVID-19 patients with fungal invasion reporting to Government SD Eye Hospital and Government ENT Hospital. The patients were evaluated for associated co-morbidities, location of fungal infection, use of steroids, oxygen therapy usage and microbiologically identified the causative fungi. Descriptive analysis was done and data was presented as numbers and percentages were calculated. Results: Overall, 470 cases of post COVID-19 suspected fungal invasion cases were referred from the Ophthalmology and ENT departments, of which 287 (61.06%) cases were culture positive for various fungal elements. Fusarium spp. was predominantly seen in 165 cases (57.49%) followed by Aspergillus spp. in 71 cases (24.74%), Mucor was isolated in 42 cases (14.64%) cases and other fungi like Candida spp. were isolated in 5 cases (1.74%) and Bipolaris spp. was seen in 4 cases (1.39%). Pre-existing Diabetes Mellitus (DM) was present in 233 cases (81.18%) cases, corticosteroid intake for the treatment of COVID-19 was recorded in 203 (70.73%) cases and oxygen therapy was administered in 160 (55.74%) cases. Conclusion: As per the evaluation especially in post COVID-19 patients there seems to be a nexus between diabetes, imprudent use of steroids, decreased immune status, inappropriate use of oxygen therapy and invasion of fungi, therefore cautious and prudent use of the steroids and oxygen among the COVID-19 treatment protocol is advised.

Status of Common Serum Minerals and Trace Elements in COVID-19 Follow-up Cases: A Hospital-based Study from Eastern India

Introduction: Management of post Coronavirus Disease-2019 (COVID-19) complications are the new challenges nowadays. It has been observed that in post COVID-19 cases the serum levels of several electrolytes and trace elements are deranged. Aim: This study was conducted to estimate the levels of different serum minerals and trace elements in one month post COVID-19 follow-up patients and compared with normal age- sex matched controls. Materials and Methods: This hospital based cross-sectional study was conducted in the Department of Biochemistry in a tertiary care centre, over a period of six months (from January 2021 to June 2021). After fulfilling proper inclusion criteria, 223 COVID-19 follow-up patients of both genders (134 males and 89 females) were included as ‘case’ group. Age-sex matched 250 healthy volunteers were recruited as ‘control’ group. Levels of serum electrolytes (sodium and potassium) and trace elements (zinc, iron, calcium, phosphate, copper, magnesium and selenium) were estimated, analysed and compared against each other. Tables and statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 20.0. Results: In this study, the levels of serum zinc and iron were found to be higher and serum calcium, phosphate, copper, magnesium and selenium levels were reduced in post COVID-19 one month follow- up cases in comparison to controls. Female cases were in deficient state of iron, calcium, copper and magnesium but had high serum zinc and phosphate when compared to males. No abnormalities were noted in the level of electrolytes in post COVID-19 cases. Conclusion: Assessment and monitoring of levels of the mineral throughout the course of post COVID-19 follow-up is advisable for timely and appropriate measures to combat with post COVID-19 complications.