The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) has been the most significant public health challenge in over a century. SARS-COV-2 has infected over 765 million people worldwide, resulting in over 6.9 million deaths. This study aimed to detect community transmission of SARS-CoV-2 and monitor the co-circulation of SARS-CoV-2 with other acute respiratory pathogens in Rift Valley, Kenya. We conducted a cross-sectional active sentinel surveillance for the SARS-CoV-2 virus among patients with acute respiratory infections at four sites in Rift Valley from January 2022 to December 2022. 1271 patients of all ages presenting with influenza-like illness were recruited into the study. Nasopharyngeal swab specimens were screened using a multiplex RT–qPCR for SARS-CoV-2, Influenza A, Influenza B and RSV. Influenza A and RSV samples were subtyped, and all the SARS-CoV-2 positive samples were further screened for 12 viral and 7 bacterial respiratory pathogens. We had a prevalence of 13.93% SARS-CoV-2, Influenza A 5.7%, Influenza B 1.96% and 0.94%. Influenza A-H1pdm09 and RSV B were the most dominant circulating subtypes of Influenza A and RSV, respectively. The most common co-infecting pathogens were Streptococcus pneumoniae and Haemophilus influenzae, accounting for 16.4% and 10.7% of all the SARS-CoV-2 positive samples. Augmenting syndromic testing in ARI surveillance is crucial to inform evidence-based clinical and public health interventions.

Background: Within the ECDC-VEBIS project, we prospectively monitored vaccine effectiveness (VE) against COVID-19 hospitalisation and COVID-19-related death, using electronic health registries (EHR), between October 2021 and November 2022, in community-dwelling residents aged 65–79 and ≥80-years in six European countries. Methods: EHR linkage was used to construct population cohorts in Belgium, Denmark, Luxembourg, Navarre (Spain), Norway and Portugal. Using a common protocol, for each outcome (hospitalisation and death), VE was estimated monthly over eight-week follow-up periods, allowing one month-lag for data consolidation. Cox proportional-hazards regression models were used to estimate adjusted hazard ratios (aHR) and VE=(1 – aHR) x100. Site-specific estimates were pooled using random-effects meta-analysis. Results: For ≥80-years, VE against COVID-19 hospitalisation decreased from 66.9% (95%CI: 60.1; 72.6) to 36.1% (95%CI: -27.3; 67.9) for the primary vaccination and from 95.6% (95%CI: 88.0; 98.4) to 67.7% (95%CI: 45.9; 80.8) for the first booster. Similar trends were observed for 65-79-years. The second booster VE against hospitalisation ranged between 82.0% (95%CI: 75.9; 87.0) and 83.9% (95%CI: 77.7; 88.4) for the ≥80-years and between 39.3% (95%CI: -3.9; 64.5) and 80.6% (95%CI: 67.2; 88.5) for 65-79-years. The first booster VE against COVID-19-related death declined over time for both age groups, while the second booster VE against death remained above 80% for the ≥80-years. Conclusions: Successive vaccine boosters played a relevant role in maintaining protection against COVID-19 hospitalisation and death, in the context of decreasing VE over time. Multi-country data from EHR facilitate robust near-real-time monitoring of VE in the EU/EEA and supports public health decision-making.

Introduction: Centralized management of queues helps to reduce the surgical waiting time in the publicly funded healthcare system, but this is not a reality in the Brazilian Unified Healthcare System. Objectives: To describe the implementation of the “Patients with Surgical Indication” (PSI) in a Brazilian public tertiary hospital; To assess the impact on waiting time and its use in rationing oncological surgeries during the COVID-19 Pandemic. Methods: Retrospective observational study of elective surgical requests (2016-2022) in a Brazilian general, public, tertiary university hospital. We recovered information regarding the inflows (indications), outflows and their reasons, the number of patients, and waiting time in queue. Results: We enrolled 82,844 indications in the PSI (2016-2022). The waiting time (median and interquartile range) in days decreased from 98(48;168) in 2016 to 14(3;152) in 2022 (p<0.01). The same occurred with the backlog that ranged from 6,884 in 2016 to 844 in 2022 (p<001). During the Pandemic, there was a reduction in the number of non-oncological surgeries per month (95% confidence interval) of -10.9(-18.0;-3.8) during Phase I (January 2019-March 2020), maintenance in Phase II (April 2020-August 2021) 0.1(-10.0;10.4) and increment in Phase III (September 2021-December 2022) of 23.0(15.3;30.8). In the oncological conditions, these numbers were 0.6(-2.1;3.3) for Phase I, an increase of 3.2(0.7;5.6) in Phase II and 3.9(1 ,4;6,4) in Phase III. Conclusion: Implementing a centralized list of surgical indications and developing queue management principles proved feasible, with effective rationing. It unprecedentedly demonstrated the decrease in the median waiting time in Brazil.

The association between traditional Chinese medicine (TCM) treatment intensity (TI) and the clinical therapeutic outcomes of patients with mild to moderate COVID-19 symptoms has not been fully understood. A retrospective cohort study was undertaken to assess the therapeutic effect of traditional Chinese medicine (TCM) on patients with mild COVID-19. Between April and May 2022, a total of 6,120 confirmed COVID-19 cases were enrolled from temporary hospitals in Shanghai City. Patients receiving TCM treatment were identified through their daily prescriptions. The nonlinearity and cutoff point of this relationship were determined using a restricted cubic spline model. The study included 6,120 mild COVID-19 cases with a median (range) age of 43.0 (2.0, 75.0) years,a median (range) hospitalization duration of 9.7 (4.1, 22.5) days, a median (range) of taking TCM of 2.0 (0.0, 15.0) days, and the median (range) negative conversion time of SARS-CoV-2 nucleic acid was 6.67 (95% confidence interval [ CI]: 4.1, 22.5) days, with 1854 women (30.3%) among the participants. The restricted cubic spline model revealed significant nonlinear association between TCMTI and the negative nucleic acid conversion time, and the statistical test results of all three parameters were statistically significant. The cutoff value of TCMTI is 0.65. The high TCMTI group showed a significant reduction in the median negative conversion time of SARS-CoV-2 nucleic acid (hazard ratio [ HR]=1.769 [95% CI: 1.575, 1.986]) and a decrease in hospitalization duration (coefficient=-0.146, P<0.001) compared with the low TCMTI group after adjustment for confounding variables. The restricted mean negative conversion time of SARS-CoV-2 nucleic acid of high TCMTI group was 1.909 (1.675, 2.144) days shorter than that of the low TCMTI group ( P<0.001). These findings could be utilized to recommend the use of TCM to treat mild COVID-19 patients and prevent overburdening of medical facilities. Trial Registration: The trial was prospectively registered on Chinese Clinical Trial Registry (ChiCTR, ChiCTR2200063151, [http://www.chictr.org.cn/](http://www.chictr.org.cn/) ).

Backgrounds: The absence of a gold-standard treatment for COVID-19 infection encourages clinicians to benefit from multipotential medications in the treatment of COVID-19. The current controlled randomized clinical trial tried to evaluate the efficacy and safety of pentoxifylline (PTX) as an adjuvant therapy in moderate to severe COVID-19 infection. Methods: In this randomized controlled clinical trial, two groups of hospitalized patients with moderate to severe COVID-19 infection were randomized by the block randomization method to either receive standard protocol therapy or standard protocol therapy plus pentoxifylline 400 mg TDS for 14 days. Results: The results showed a greater improvement in the proinflammatory biomarkers in the intervention group. Oxygen saturation, hemoglobin, and platelet levels were also improved to a higher level among pentoxifylline recipients. The mortality rate was reported 4% and 32% in the intervention and control groups, respectively. One out 13 patients with severe COVID-19 infection expired in the intervention group, while 20 out of 28 patients expired in the control group, showing about 10 times higher mortality rate compared to the pentoxifylline recipients. Conclusion: Pentoxifylline increased the survival rate of COVID-19 patients and played as a preventive role for COVID-related mortality and morbidity such as acute respiratory distress syndrome.

Background: In emergency departments, rapid screening of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is important for arranging limited isolation resources and patient care during the coronavirus disease 2019 (COVID-19) pandemic. STANDARD M10 SARS-CoV-2 (SD Biosensor) is a recently developed cartridge-based RT-PCR that provides a turnaround time of 1 h, which is shorter than that for conventional RT-PCR. This study evaluated the clinical performance of STANDARD M10 in an emergency department. Methods: From March to June 2022, two pairs of nasopharyngeal and oropharyngeal swabs were collected from patients visiting an emergency department. Respective specimens underwent rapid RT-PCR using STANDARD M10 and conventional RT-PCR using Allplex SARS-CoV-2 (Seegene). When discordant results occurred, specimens undergoing the STANDARD M10 were retested with the Allplex to exclude specimen variations. Retest results replaced initial results of the Allplex. Clinical performance of STANDARD M10 was compared with Allplex. Results: The study enrolled 1,971 patients. COVID-19 prevalence was 6.2% based on the Allplex. Compared with the Allplex, overall agreement, positive percent agreement, and negative percent agreement of STANDARD M10 were 99.5% (95% CI: 99.1–99.8%), 95.9% (95% CI: 90.8–98.3%), and 99.8% (95% CI: 99.4–99.9%), respectively. Discordant results between STANDARD M10 and Allplex were observed only in specimens with Ct >33 using the Allplex. Conclusions: The STANDARD M10 showed reliable diagnostic performance for detecting SARS-CoV-2 in emergency departments and is a useful tool in emergency healthcare systems because of its easy-to-use cartridge-based assay and short resulting time for detecting SARS-CoV-2.

Rabies is an ancient neuroinvasive viral (genus Lyssavirus, family Rhabdoviridae) disease affecting approximately 59,000 people worldwide. The central nervous system (CNS) is targeted, and rabies has a case fatality rate of almost 100% in humans and animals. Rabies is entirely preventable through proper vaccination, and thus, the highest incidence is typically observed in developing countries, mainly in Africa and Asia. However, there are still cases in European countries and the US. Recently, demographic, increasing income levels, and the coronavirus disease 2019 (COVID-19) pandemic have caused a massive raising in the animal population, enhancing the need for preventive measures (e.g., vaccination, surveillance, animal control programs), post-exposure prophylaxis, and a better understanding of rabies pathophysiology to identify therapeutic targets, since there is no effective treatment after the onset of clinical manifestations. Here we review the neuroimmune biology and mechanisms of rabies. Its pathogenesis involves a complex and poorly understood modulation of immune and brain functions associated with metabolic, synaptic, and neuronal impairments, resulting in fatal outcomes without significant histopathological lesions in the CNS. In this context, the neuroimmunological and neurochemical aspects of excitatory/inhibitory signaling (e.g., GABA/glutamate crosstalk) are likely related to the clinical manifestations of rabies infection. Uncovering new links between immunopathological mechanisms and neurochemical imbalance will be essential to identify novel potential therapeutic targets to reduce rabies morbidity and mortality.

Despite the effectiveness of COVID-19 vaccination in reducing the severity of the disease, the demand for booster is increasing in vulnerable populations like elderly and immunocompromised individuals especially with each new wave of COVID-19 in different countries. There is limited data on the sustained immunity against COVID-19 in patients with liver cirrhosis. The study was aimed to compare the T-cell and humoral immune response after one year of ChAdOx1nCoV-19 Vaccine in patients with liver cirrhosis and healthy health-care workers (HCW). This was a prospective observational study including 36 HCW,19 liver cirrhosis patients and 10 unvaccinated individuals. Anti-SARS-CoV-2S antibody, neutralizing antibody and memory T-cell subsets were evaluated by ELISA and flow cytometry respectively in all three groups after one year of initial vaccination. Compared to HCW and unvaccinated individuals, liver cirrhosis patients had significantly depleted T-cells, although CD4:CD8+ T-cell ratio was normal. Significant difference was noted in various memory subsets [effector memory RA (P= 0.141, P= 0.000), effector memory (P= 0.000, P= 0.00), central memory (P= 0.000, P= 0.00), stem cell memory (P= 0.009, P= 0.08) and naïve (P= 0.000, P= 0.02)] of CD4+T and CD8+T respectively. However, on post-hoc analysis no difference was noted in the extent of memory T-cells between cirrhotic patients and HCW. Patients with liver cirrhosis developed comparable memory T-cells after vaccination which can evoke sustainable immune response on reinfection. Therefore, additional vaccine doses may not be necessary for cirrhosis patients.

Introduction: During the COVID-19 pandemic, pediatric visits due to acute lower respiratory infections (ALRIs) decreased, but most reports are from hospitalized patients. There is little information on this phenomenon in outpatients, who are the majority in IRABs. We evaluated the impact of the COVID-19 pandemic on ALRIs related outpatient visits in the City of Buenos Aires. Methods: Observational study including all outpatient visits of children under 2 years of age to the public health system of the City of Buenos Aires, between Jan 01, 2018 and Dec 31, 2022. We estimated the total number visits and the ALRIs-related visits, and their distribution throughout the study period. Results: A total of 704,426 visits were registered, 7.38% of them due to ALRIs. ALRIs-related visits decreased from the implementation of a national lockdown (2020) and increased again as the restriction measures decreased, particularly the return to full school attendance (2021). In general, the proportion of ALRIs-related vists was significantly higher in the cold months than in the warm ones (9.8% vs. 5.5%; OR: 1.76, 95%CI: 1.73-1.79; p<0.001). This difference was observed before (2018, 2019) and after the pandemic (2022), but not in 2020-2021. The peak of ALRIs-related visits occurred in the cold months in pre-pandemic years (2018-2019), did not appear in 2020, reappeared delayed in 2021 and recovered seasonality in 2022. Conclusion: Outpatient ALRIs-related visits decreased significantly in the city of Buenos Aires during the COVID-19 pandemic and currently seem to have recovered their magnitude and seasonality.

I was infected with the Covid-19 virus .On the seventh day after sickness , 0.1 ml (log 108 /ml) of live Newcastle (strain I 2 ) vaccine was inoculated through nasal drops .After about 12 hours, unbelievably all the symptoms of Covid-19 were disappeared .

Background: The outbreak of SARS-COV-2 has necessitated the implementation of urgent measures to suppress the transmission of the virus, including the mandatory public use of masks, regular hand washing, and social distancing. These measures may also be effective in reducing other respiratory infectious deseases, such as Influenza and severe acute respiratory illness. Therefore, the aim of the study was to estimate the prevalence of respiratory pathogens among SARS-CoV2 non-reactive patients, admitted in healthcare facilities in the context of COVID-19 management. Material and Method: From February to July 2021, a total number of 167 nasopharyngeal swabs from adults fitting the case definition of COVID-19 syndrome and negative to SARS-CoV-2 were enrolled from seven regional sites in Morocco.All samples were subject to a multiplexed nucleic acid test intended for the simultaneous detection and differentiation of 22 respiratory pathogens. Results: Our study showed that overall, theprevalence of respiratory pathogens was 43% (n=72). The main detected pathogens were typed as Human Rhinovirus (HRV) (38%), Human Coronavirus OC43 (37%) and Human Parainfluenza3 (HPIV3) (12%). Conclusion: Our findings support the notion that during the SARS-CoV2 pandemic, the detection of Influenza A/B, Human Metapneumovirus, and Respiratory Syncytial Virus all declined. Meanwhile, there was a noticeable increase in HRV and HCoV OC43. The dynamics of airborne transmission and epidemic patterns were thus assumed to be greatly improved by the SARS-CoV-2 prophylactic measures. These findings could be useful in guiding future prevention and management of respiratory illnesses.

During the Covid-19 pandemic, the resurgence of SARS-CoV-2 was due to the development of novel variants of concern (VOC). Thus, genomic surveillance is essential to monitor continuing evolution of SARS-CoV-2 and to track the emergence of novel variants. In this study, we performed phylogenetic, mutation, and selection pressure analyses of the Spike, nsp12, nsp3, and nsp5 genes of SARS-CoV-2 isolates circulating in Yogyakarta and Central Java provinces, Indonesia from May 2021 to February 2022. Various bioinformatics tools were employed to investigate the evolutionary dynamics of distinct SARS-CoV-2 isolates. During the study period, 213 and 139 isolates of Omicron and Delta variants were identified, respectively. Particularly in the Spike gene, mutations were significantly more abundant in Omicron than in Delta variants. Consistently, in all of four genes studied, the substitution rates of Omicron were higher than that of Delta variants, especially in the Spike and nsp12 genes. In addition, selective pressure analysis revealed several sites that were positively selected in particular genes, implying that these sites were functionally essential for virus evolution. In conclusion, our study demonstrated a distinct evolutionary pattern of SARS-CoV-2 variants circulating in Yogyakarta and Central Java provinces, Indonesia.

Background: The seroepidemiological characteristics of SARS-CoV-2 infection in Mali are not yet well understood. This study assessed SARS-CoV-2 antibody seroprevalence and factors associated with infection in the general population of Bamako, the capital city and epicenter of COVID-19, to determine the magnitude of the pandemic and contribute to control strategies improvement in Mali. Methods: A cross-sectional survey was conducted in September 2022 to collect data on sociodemographic information, clinical characteristics, comorbid factors, and blood samples. ELISA was performed to determine anti-Spike (S) and anti-RBD antibody levels, and RT-PCR to confirm SARS-CoV-2 infection in oropharyngeal swabs. A total of 3601 participants were enrolled in RedCap. Result: the mean age of participants was 33.5±15.9 years old; the sex ratio female: male was 3.6:1. The most representative were the 20–29 (28.9%, n=1043) and the 30–39 (26.9%, n=967) years-old. The COVID-19 vaccine coverage among the participants was 35.8%, with vaccines from Covidshield AstraZeneca (AZ, 13.4%), Johnson and Johnson (J&J, 16.7%), Sinovac (3.9%), and BioNTech Pfizer (1.8%). Overall, S protein and RBD antibodies seroprevalence was remarkably high in the general population (98% and 97%, respectively). Factors such as youth (1–9 years old) and male sex were associated with lower antibody responses against S and RBD, whereas previous exposure to patients with COVID-19 and receiving the COVID-19 vaccine were associated with increased odds of antibody responses. Conclusion: This serosurvey demonstrated the high seroprevalence of SARS-CoV-2 antibodies and highlighted the factors that may influence antibody responses, clearly underlining an underestimation of the pandemic in Mali.

Objectives The aim of this study was to assess the potential of noninvasive and repeated monitoring of rhACE2 distribution and content in organs using the ACE2-specific nuclide probe 68Ga-HZ20. Methods We optimized the labeling conditions of the probe and evaluated its safety. A mouse organ in situ rhACE2 high-aggregation model was constructed for the first time, and in vivo real-time PET imaging of rhACE2 was performed using the ACE2-specific PET agent 68Ga-HZ20. The distribution and uptake of the probe were analyzed, and the model was validated. Results This radiotracer exhibited reliable radiochemical properties in vitro and maintained a high affinity for rhACE2 in vivo. In terms of probe uptake, 68Ga-HZ20 showed a good target-to-nontarget ratio, and the correlation between the uptake value of the probe and the dose of rhACE2 was >90% in both models; the probe was rapidly cleared from the circulatory system and excreted by the kidneys and urinary system. No organs were damaged after the injection of high doses of probe. Conclusions This technology for noninvasively and repeatedly monitoring the content and distribution of rhACE2 in vivo aids in clarifying the resident capacity of rhACE2 in organs and in analyzing the preventive effect of rhACE2 against SARS-CoV-2 and the effectiveness of therapies for COVID-19.

Cameroon was among the most affected African countries during the first wave of the COVID-19 pandemic; however, the true prevalence of SARS-CoV-2 remains unknown. From October-December 2020 we conducted a cross-sectional, age-stratified SARS-CoV-2 seroepidemiological survey at 30 purposively selected community-based sites across Cameroon’s 10 regional capitals, sampling 10,000 individuals aged 5 years or older. We employed a parallel SARS-CoV-2 antibody testing algorithm (WANTAI ELISA and Abbot Architect) to improve both the positive predictive value and negative predictive value of seroprevalence. The overall weighted and adjusted seroprevalence of SARS-CoV-2 antibodies across the 10 urban capitals of Cameroon was 10.5% (95% CI: 9.1%-12.0%) among participants aged ≥5 years. Of the 9332 participants, 730 males (13.1%, 95% CI: 11.5%-14.9%) had SARS-CoV-2 antibodies compared to 293 females (8.0%, 95% CI: 6.8%—9.3%). Among those who reported a comorbidity at the time of testing, 15.8% (95% CI: 12.8%-19.4%) were seropositive. We estimated that over 2 million SARS-CoV-2 infections occurred in the 10 regional capitals of Cameroon between October and December 2020, compared to 21,160 cases officially reported at that time translating to one laboratory-confirmed case was reported for every 110 SARS-CoV-2 infections across the 10 urban capitals. This study’s findings point to extensive and under-reported circulation of SARS-CoV-2 in Cameroon– an almost 100-fold more cases compared to the number of cases reported to the World Health Organization. This finding highlights the importance of conducting serosurveys, especially in settings where access to testing may be limited and to repeat such surveys as part of pandemic tracking.

A document by Mohammad Hazique . Click on the document to view its contents.

COVID-19 bivalent ancestral/Omicron mRNA booster vaccinations became available to boost and expand the immunity against SARS-CoV-2 Omicron infections. In a prospective cohort study including 59 healthcare workers, we assessed SARS-CoV-2 ancestral and Omicron BA.5-specific neutralizing antibody and T cell responses in previously infected and infection-naive individuals. Also, we assessed the effect of an ancestral/Omicron BA.1 bivalent mRNA booster vaccination on these immune responses. 10 months after previous monovalent mRNA vaccinations, ancestral SARS-CoV-2 S1-specific T cell and anti-RBD IgG responses remained detectable in most individuals and a previous SARS-CoV-2 infection was associated with increased T cell responses. T cell responses, anti-RBD IgG, and Omicron BA.5 neutralization activity increased after receiving an ancestral/Omicron BA.1 bivalent booster mRNA vaccination. An Omicron BA.5 infection in addition to bivalent vaccination led to a higher ratio of Omicron BA.5 to ancestral strain neutralization activity compared to bivalent vaccination without a recent SARS-CoV-2 infection. In conclusion, SARS-CoV-2 T cell and antibody responses persist for up to 10 months after a monovalent booster mRNA vaccination. An ancestral/Omicron BA.1 bivalent booster mRNA vaccination increases these immune responses and also induces Omicron BA.5 cross-neutralization antibody activity. Finally, our data indicate that hybrid immunity is associated with improved preservation of T cell immunity.

The WHO Unity Studies initiative engaged low- and middle-income countries in the implementation of standardized SARS-CoV-2 sero-epidemiological investigation protocols and timely sharing of comparable results for evidence-based action. To gain a deeper understanding of the methodological challenges faced when conducting seroprevalence studies in the Africa region, we conducted unstructured interviews with key study teams in five countries. We discuss the challenges identified: participant recruitment and retention, sample frame, sample and data management, data analysis and presentation to policy makers. Potential solutions to aid future implementation include preparedness actions such as the development of new tools, robust planning and practice.

Clinical and histopathological evidence suggest that the male reproductive system may be negatively impacted in patients with coronavirus disease (COVID-19). The objective of this study is to investigate the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on semen parameters by comparing semen analyses before and after COVID-19 diagnosis in the same patient. We retrospectively analyzed 342 semen analyses by reviewing medical records. The study included two groups of patients: (i) those who underwent two consecutive semen analyses within 6 months, one before (n=114) and one after (n=114) COVID-19 diagnosis, and (ii) a control group (n=114) that was age-matched and did not receive a diagnosis of COVID-19. The study results indicated a significant decrease in semen volume, total sperm count per ejaculate, progressive motile sperm count, total motile sperm count, and normal sperm morphology after SARS-CoV-2 infection in comparison to their respective values before the infection. Subgroup analyses showed that the duration of COVID-19 diagnosis (short-term vs long-term) did not impact the changes in semen parameters. However, fever during the COVID-19 process had a negative effect on semen parameters, particularly sperm concentration, unlike in patients without fever. In conclusion, our findings suggest that SARS-CoV-2 infection is associated with a decline in semen quality, which may potentially impact male fertility. Furthermore, it’s important to note that the negative effects on semen parameters may persist in the long-term. Our results also indicate that fever during active infection could be a significant risk factor that negatively affects spermatogenesis.

The deployment of e-assessments has been so frequent in educational institutions worldwide during the COVID-19 pandemic. It is worth questioning the efficacy of this newly adopted evaluation method. The study aims to determine how far this testing effectively achieves the Course Learning Outcomes. It also tries to explore the extent of difference between the online assessment method from the pre-pandemic testing methods stated in the course specification. Another aim of the study is to check the acceptance of e-tests by the learners. This study employs a quantitative approach encompassing a Likert-type online questionnaire to gather the response of 70 faculty members at XXXX in Saudi Arabia. The primary result of this study is that e-assessment succeeds in attaining Course Learning Outcomes to a great extent. Though these newly adopted tests shifted away from the stated measurement methods in the course specification, the learners accepted them enthusiastically. It was discovered in the study that if educational institutes have well-structured e-learning infrastructures and regularly use these setups competently, they confront minor complexities to switching to online ones and achieve Course Learning Outcomes applying e-assessment systems.

Introduction: Coronavirus disease-2019 (COVID-19) is a novel infection, that first appeared in Wuhan, China. It has been well established that different organs including the heart, kidney, pulmonary and gastrointestinal systems might be involved during or post COVID-19 infection. A possible reason is that the virus enters host cells through the angiotensin-converting enzyme 2 (ACE 2) receptor and this receptor is expressed by different human organs [1]. ACE 2 receptor is also expressed in different parts of the eyes including the conjunctiva, cornea, limbus, aqueous humor, and retina [2].In addition, COVID-19-associated multisystem inflammatory syndrome in children (MIS-C) can affect different organ systems including skin, renal, cardiac, hematological, and gastrointestinal systems. But ocular involvement is not still a part of the world health organization (WHO) criteria or the Center for Disease Control and Prevention criteria for MIS-C [3].Whether uveitis or optic disk edema would be manifestations of acute COVID-19 infection or they can occur as a part of COVID-19-associated MIS-C is still unknown.

Human Adenoviruses (HAdV) are implicated in multiples pathologies causing mild to severe disease. The predominant genotypes detected in association with disease differ among different countries or regions, and change over time. In Spain and elsewhere little is known about the molecular epidemiology of HAdV. From a total of 250 HAdV, members of five species were present: A (1), B (126), C (87), D (27) and E (9). The most found genotypes were B3 (119), C2 (48), C1 (29) and D8 (26). Genotypes E4, C5, C6, B7, A31, B35 and D56 were also detected. HAdV diversity increases over the years until the B3 genotype displaces all other types in 2016 and 2023. HAdV detected in Asturias were similar to those already described in other countries, no new local genotype were observed. Genotypes 1-7 were more frequent in children under 15 years of age, while types 8-56 were more frequent in the elderly. Multiple HAdV introductions must have occurred given that only small transmission clades can be inferred. The diversity of the epidemic increased with the years until it disappeared one year periodically .The COVID-19 epidemic accelerated the loss of diversity suggesting that interventions during the pandemic were able to reduce HAdV transmission.

A Novel Treatment Paradigm for the Treatment of COVID-19 Induced Acute Respiratory Distress Syndrome (ARDS) Acute respiratory distress syndrome due to the SARS-CoV-2 virus (COVID-19 ARDS) demonstrates the same pathologic changes of diffuse alveolar damage as classic ARDS, and ARDS develops in 33%-42% of hospitalized patients with COVID-19 and in 61-81% of patients admitted to the intensive care unit (ICU).1,2 Regardless of etiology, ARDS treatment options are limited to supportive care with mechanical ventilation (MV) and new, effective treatments are needed.3ExoFloTM is an acellular extracellular vesicle (EV) product isolated from a single donor bone marrow mesenchymal stem cell (bmMSC) culture that confers the promising anti-inflammatory and regenerative benefits of bmMSCs for treatment of ARDS without the drawbacks associated with viable cell therapy.4-12 We proposed that ExoFlo could safely reduce lung injury from COVID-19, and possibly assist in the lung’s recovery process. We describe the case of a patient with severe respiratory failure and subsequent ARDS requiring prolonged mechanical ventilation who recovered after receiving ExoFlo. This case highlights this EV product as a novel therapeutic for the treatment of COVID-ARDS.The patient is a 40-year-old female with a history of mild intermittent asthma, diverticulosis, and a remote history of thyroid cancer status post thyroidectomy. The patient had a prolonged ICU course due to COVID-19 induced ARDS that started four days after delivering her second child via a Cesarean section. Treatment for ARDS included mechanical lung ventilation with prone positioning, treatment of secondary infections with intravenous antibiotics, and supportive care for multisystem organ failure. She also received standard supportive care for COVID ARDS including lung protective ventilation, intermittent neuromuscular blockade, and intravenous steroids.After one month of supportive care failed to improve her status, an eIND (IND #28207) was approved by the Food and Drug Administration (FDA) for the administration of 15 mL of ExoFlo. At the time of ExoFlo administration, she was sedated with an FiO2 of 100% and PEEP of 15cm H2O, and she was receiving norepinephrine to maintain adequate perfusion. She received two doses of ExoFlo on Day 1 and Day 2 with slight improvement. She was not considered a candidate for extracorporeal membrane oxygenation (ECMO) due to the prolonged mechanical ventilation. Seventeen days later, she continued having febrile episodes and still required maximum ventilatory support. Her FiO2 on the ventilator was 90% and her PEEP was at 14cm H2O. Since her lung function had not improved, an additional treatment course of ExoFlo was approved by the FDA. After the second day of her second course of ExoFlo treatment, we were able to wean the PEEP, wean sedation and she began to move her lower extremities again. Due to this clear improvement, she continued the ExoFlo treatment course with 15 mL every 24 hours for a total of 5 days. By the fifth dose of ExoFlo, her ventilatory requirements had improved to 55% FiO2 and a PEEP of 8. The day after her fifth dose, two months from her ARDS diagnosis, she underwent a bedside tracheostomy and PEG tube placement.Two days following her second round of ExoFlo treatment, her sedation continued to be weaned, her urine output began to increase, and she was initiated on oral intake with ice chips. Two weeks following this treatment course, the FDA approved a third treatment course with ExoFlo. Following her third course of ExoFlo (5 days, 15 mL Q 24 hours) her tracheostomy was downsized, ventilatory support was discontinued, and she achieved 96% oxygen saturation on trach collar. (Figure 1. A. Chest computed tomography (CT) imaging before five-day course of ExoFlo. B. Chest CT showing improvement after five-day course of ExoFlo.)Four days after her third treatment course with ExoFlo, she was discharged from the hospital to a rehabilitation facility. She was still regaining strength and remained on oxygen at rest. Eight months after discharge from the hospital, she was able to return to work part time. One year after discharge, she has regained most of her strength. She still has some fine motor deficits in her right hand, and she still requires oxygen with exertion. She has a mild restrictive pattern and mild DLCO reduction on her pulmonary function tests, but her chest CT and overall functional status have both greatly improved. Her most recent CT shows improvement in the fibrotic injury appreciated on her earlier chest CTs. (Figure 2. A. Chest CT before five-day course of ExoFlo B. Chest CT one year after discharge from hospital).Prior to her second course of ExoFlo, the ICU team was discussing palliative care options with the family, since she was in the severe COVID ARDS category of patients who often did not recover. Once she started showing signs of major improvement during her second course of treatment with ExoFlo, it became apparent that she had a good chance for a meaningful recovery. The multiplicity of molecules contained within ExoFlo may have promoted healing and regeneration of healthy lung tissue in this patient who appeared to have irreversible ARDS. Currently a Phase III, randomized, blinded trial is underway to evaluate the efficacy of ExoFlo in patients with moderated to severe COVID related ARDS.

Background: The transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is complex and multifactorial. We aimed to identify the risk factors for infection among the household contacts of index patients and to determine the incubation period, serial interval, and estimates of secondary infection rate. Methods: We conducted a study in three districts of Kerala among the inhabitants of households of reverse transcriptase polymerase chain reaction (RT-PCR)-positive coronavirus disease (COVID-19) patients between January and July 2021. COVID-19-positive patients and corresponding contacts were enrolled and followed up for 28 days to determine RT-PCR positivity and the presence of total antibodies against SARS-CoV-2 on days 1, 7, 14, and 28 from the date of enrolment. Results: The mean incubation period, serial interval, and generation time were 1.6, 3, and 3.9 days, respectively. The secondary infection rate was 43.0%. Individuals who worked outside the home were protected, whereas those who had kissed the COVID-19-positive patients during illness were more than twice at risk of infection than those who had not kissed the COVID-19-positive patients. Similarly, the contacts who had shared a toilet with the COVID-19-positive patients were more at risk than those who had not shared a toilet. However, the contacts who reported using masks were at a higher risk of infection in household settings. Conclusions Assessment of SARS-CoV-2 transmission in household settings is important, considering its high secondary infection rate. Close physical contact and toilet sharing increase the risk of infection. This study demonstrates shorter incubation period and serial interval.