Uncommon manifestations of COVID-19 have a great risk of going undiagnosed for longer time. Diabetes is reported to be a long-term consequence of SARS-CoV-2 infection. Thus, heightened awareness and timely recognition of diabetes after COVID-19 infection are important for occupational physicians treating healthcare workers with COVID-19.

The rapid adaptation of SARS-CoV-2 within the host species and the increased viral transmission triggered the evolution of different SARS-CoV-2 variants. Though numerous monoclonal antibodies (mAbs) have been identified as prophylactic therapy for SARS-CoV-2, the ongoing surge in the number of SARS-CoV-2 infections shows the importance of understanding the mutations in the spike and developing novel vaccine strategies to target all variants. Here, we report the map of experimentally validated 74 SARS-CoV-2 neutralizing mAb binding epitopes of all variants. The majority (87.84%) of the potent neutralizing epitopes are localized to the receptor-binding domain (RBD) and overlap with each other, whereas limited (12.16%) epitopes are found in the N-terminal domain (NTD). Notably, 69 out of 74 mAb targets have at least one mutation at the epitope sites. The potent epitopes found in the RBD show higher mutations (4-10aa) compared to lower or modest neutralizing antibodies, suggesting that these epitopes might co-evolve with the immune pressure. The current study shows the importance of determining the critical mutations at the antibody recognition epitopes, leading to the development of broadly reactive immunogens targeting multiple SARS-CoV-2 variants. Further, vaccines inducing both humoral and cell-mediated immune responses might prevent the escape of SARS-CoV-2 variants from neutralizing antibodies.

We present a case of new-onset hyperthyroidism with autoimmune thyroid disease which developed four weeks after COVID-19 infection. The patient responded well to methimazole and beta blockers in combination. Three similar cases have been described and their clinical features and investigation results are compared with those in our case.

Background: COVID-19 vaccine is critical in preventing SARS-CoV-2 infection and transmission. However, obesity’s effect on immune responses to COVID-19 vaccines is still unknown. Methods: We performed a meta-analysis of the literature and compared immune responses to COVID-19 vaccines among persons with and without obesity. We used Pubmed, Embase, Web of Science, and Cochrane Library to identify all related studies up to April 2022. The Stata.14 software was used to analyze the selected data. Results: Totally, 11 studies were included in the present meta-analysis. Five of them provided absolute values of antibody titers in the obese group and non-obese group. Overall, we found that the obese population was significantly associated with lower antibody titers (SMD = -0.228, 95% CI (-0.437, -0.019), P<0.001) after COVID-19 vaccination. Significant heterogeneity was present in most pooled analyses but was reduced after subgroup analyses. No publication bias was observed in the present analysis. The Trim and Fill method did not change the results in the primary analysis. Conclusion: The present meta-analysis suggested that obesity was significantly associated with decreased responses to SARS-CoV-2 vaccines. Future studies should be performed to unravel this relationship to prevent COVID-19 infection and transmission.

Background There is a need for vaccines that can induce effective systemic, respiratory mucosal and cellular immunity to control the COVID-19 pandemic. We reported previously that a synthetic mucosal adjuvant SF-10 derived from human pulmonary surfactant works as an efficient antigen delivery vehicle to antigen presenting cells in the respiratory and gastrointestinal tracts and promotes induction of influenza virus antigen-specific serum IgG, mucosal IgA and cellular immunity. Methods The aim of the present study was to determine the effectiveness of a new administration method of intratracheal (IT) vaccine comprising recombinant SARS-CoV-2 spike protein 1 (S1) combined with SF-10 (S1-SF-10 vaccine) on systemic, local and cellular immunity in mice, compared with intramuscular injection (IM) of S1 with a potent adjuvant AS03 (S1-AS03 vaccine). Results S1-SF-10-IT vaccine induced S1-specific IgG and IgA in serum and lung mucosae. These IgG and IgA induced by S1-SF-10-IT showed significant protective immunity in a receptor binding inhibition test of S1 and angiotensin converting enzyme 2, a receptor of SARS-CoV-2, which were more potent and faster achievement than S1-AS03-IM. Enzyme-linked immunospot assay showed high numbers of S1-specific IgA and IgG secreting cells (ASCs) and S1-responsive IFN-γ, IL-4, IL-17A cytokine secreting cells (CSCs) in the spleen and lungs. S1-AS03-IM induced IgG ASCs and IL-4 CSCs in spleen higher than S1-SF10-IT, but the numbers of ASCs and CSCs in lungs were low and hardly detected. Conclusion Based on the need for effective systemic, respiratory and cellular immunity, the S1-SF-10-IT vaccine seems promising mucosal vaccine against respiratory infection of SARS-CoV-2.

Bell's palsy is an acute peripheral facial paralysis commonly associated with viral infections. COVID-19 may be a potential cause of peripheral facial paralysis and other neurological manifestations. We report a case of Bell's palsy due to COVID-19 infection in a previously healthy 35 -year- old male.

Comment on: Effects of COVID-19 vaccination on platelet counts and bleeding in children, adolescents, and young adults with immune thrombocytopenia

Background:There are limited data on etiology of viral pneumonia under the impact of COVID-19 pandemic. We aimed to investigate the changes of viral pneumonia before and after COVID-19 pandemic among patients diagnosed with pneumonia. Methods:This is a single-center retrospective study. Patients hospitalized with pneumonia during January 1,2016 and Dec 31,2021 in West China Hospital were included and divided into pre- and post-COVID-19 groups according to the point of COVID-19 outbreak in China which was December 8,2019. Results of the 13 viral nucleic acid tests were compared between the two groups. Results:5,928 patients were analyzed,3,945 in the pre-COVID-19 group while 1,983 in the post-COVID-19. Respiratory viral nucleic acid screening proportion was riseing after COVID-19 (14.8％ VS 22.8％).But the positive rate of post-COVID-19 total virus and Influenza virus had decreased 23.3% and 18.3%, respectively,p＜0.05. The top three viral pneumonia were InfAH1N1(2009),Human Rhinovirus,Human Adenovirus before COVID-19, while HRV, Human Parainfluenza virus, Human Respiratory Syncytial virus after COVID-19 pandemic. Notebly,InfAH1N1(2009) pneumonia decreased to 0％ after the pandemic. Conclusions:Proportion of viral pneumonia has significantly decreased under the impact of COVID-19 pneumonia and the incidence of InfAH1N1(2009) pneumonia is almost 0.

There is a strong scientific rationale to use nebulised unfractionated heparin (UFH) in COVID-19. This pilot study investigated whether nebulised UFH was safe and had any impact on mortality, length of hospitalisation and clinical progression, in the treatment of hospitalised patients with COVID-19. This parallel group, open label, randomised trial included adult patients with confirmed SARS-CoV-2 infection admitted hospital in Brazil. One hundred patients were planned to be randomised to either “standard of care” (SOC) or SOC plus nebulized UFH. The trial was stopped after randomisation of 75 patients due to falling COVID-19 hospitalisation rates. Significance tests were 1-sided test (10% significance level). The key analysis populations were intention to treat (ITT) and modified ITT (mITT) which excluded (from both arms) subjects admitted to ITU or who died within 24 hrs of randomisation. In the ITT population (n=75), mortality was numerically lower for nebulised UFH (6 out of 38 patients; 15.8%) versus SOC (10 out of 37 patients; 27.0%), but not statistically significant; odds ratio (OR) 0.51, p=0.24. In the mITT population, nebulised UFH reduced mortality (OR 0.2, p=0.035).

This article reports a six-year-old case with a complaint of acute respiratory distress syndrome and malaise who had a positive Covid-19 test.After intraoral examination Dehiscence was remarkable on the dentoalveolar area in the posterior Mandible.Surgical resection of Necrotic bone was performed,and the patient was treated completely.

Coronavirus disease 2019 (COVID-19) can cause various complications. Pneumothorax secondary to COVID-19 is relatively uncommon and bilateral pneumothorax is even more so. In patients with poor general health to undergo surgery for pneumothorax, internal treatments are essential to relieving refractory pneumothorax.

A document by Fatih Cesur. Click on the document to view its contents.

Psychological stress has evolved as an important health concern across the globe. The vulnerability to stress and the ramifications of it have only worsened during the time of the COVID-19 pandemic. This necessitates a timely diagnosis of stress before the condition progresses to chronicity. In this context, the popularity of social media like Twitter, where large numbers of users share opinions without any social stigma, has emerged as a major resource of human opinions. This has led to an increased research interest in social media-based stress detection techniques. However, tweet-level stress detection techniques in the literature have left a void in leveraging the text information in tweets, especially the presence of sarcastic expressions in the tweet’s text content. To this end, a novel method called “Sarcasm-based Tweet-Level Stress Detection” (STSD) is proposed in this work with the modification of the logistic loss function to detect tweet-level stress by availing the information of sarcasm that exists in the tweet-content. The principle of the STSD model is to minimise the loss for non-sarcastic tweets while maximising the loss for sarcastic tweets. Furthermore, an extensive preprocessing and dimensionality reduction is performed using kernel principal component analysis (kernel PCA) to improve the performance by reducing the dimensions. The experimental results show that the proposed STSD model, when applied along with kernel PCA, records a significant improvement in accuracy by a minimum of 5.25% and a maximum of 9.19% over baseline models. Also, there is an increment in F1-score by at least 0.085 points and a maximum of 0.164 points when compared to the baseline models.

Introduction: In the United States the impact of the COVID-19 pandemic on atrial fibrillation (AF) related mortality has not been described. Methods: AF related mortality data were extracted for the years 2018-2020 from the Centers for Disease Control and Prevention (CDC), the Wide-ranging Online Data for Epidemiologic Research (WONDER) database. We compared main causes of AF related mortality and age adjusted mortality rate (AAMR) among different subgroups in the years 2018-2019 vs 2020 to reveal patterns of increased mortality. Results: Compared to 2018-2019, we observed a 18% increase in AF related age adjusted mortality in 2020 (52.2 vs 44.25 per 100,000 vs population). In 2020, COVID-19 was the third most common main cause of death among people with AF (8% of deaths, AAMR of 4.9 per 100,000). Examination of the relative increase in AF related mortality among different subgroups revealed a more prominent increase among males (21% increase vs 14.5% among females) those younger than 65 years old (30% increase, vs. 16% among those younger than 65 years old), and among racial and ethnic minorities. Conclusion: There was a sharp rise in AF related mortality during the first pandemic year. Males, those from younger age groups, and ethnic minority groups showed the largest increases in mortality. Targeted health policies could help address the disparities observed in this analysis.

Background: Thailand’s fourth and fifth waves of coronavirus disease 19 (COVID-19) started in July and December 2021, respectively, and greatly overloaded the nation’s public health system. The massive imbalance between health resources and patient demand for services was one of the most significant challenges hampering the country’s response to the catastrophic COVID-19 pandemic. Hospital-based facilities were overwhelmed with an exponential rise in new patient numbers, with a rapidly growing backlog of patients with delayed care or even acceptance within the healthcare system. In response, “outpatient self-isolation” (SI), “home-based isolation” (HI), and “community-based isolation” (CI) strategies were adopted to stabilize COVID-19 cases with mild to moderate symptoms. We present the lessons learned from the system management of HI by drawing on the experiences gained at a university hospital that provided patient-to-professional remote support during the pandemic. The vast majority of patients were assigned to HI immediately after being diagnosed with COVID-19. This system enabled remote consultation, needed medications, and survival-kit supplies to be initiated and delivered to patients’ homes. Conclusion: Our investigation indicates that the HI teleconsultation system was a productive approach to COVID-19 management. It allowed a prompt response to patients’ needs and provided timely access to medical support, especially for patients with mild to moderate symptoms.

The paper studies the method for online teaching using Multi-Track Modular Teaching (MT2). MT2 is an advanced teaching-learning method for better training of students with deep skills.  Covid19 pandemic and the associated lockdown periods, coupled with the requirements of social distancing, have played a major disruption in the academic processes across all the world’s universities. Due to the inability to conduct physical classes and lectures, most universities have opted for online classes using video conference tools. One way to make the computer networking classes, during lock-down periods, more effective is to use the Multi-Track Modular Teaching (MT2) technique which organizes a course into multiple tracks and modules. This paper presents the mod?ifications carried out to MT2-based computer networking course and experiences from teaching it online during the lock-down period. While the online classes offered an alter?native to the completely disrupted teaching and learning process, observations on their effectiveness reveal certain important considerations in order to make them more useful. Results from a feedback survey of the students who under?took the course is also provided in this paper, giving insights to certain difficulties and issues in the conduct of online classes in developing countries.

Introduction: During the early phase of the coronavirus disease 2019 (COVID-19), remdesivir was only approved for hospitalized patients. Our institution developed hospital-based, outpatient infusion centers for selected hospitalized patients with COVID-19 who had clinical improvement to allow for early dismissal. The outcomes of patients who transitioned to complete remdesivir in the outpatient setting were examined. Methods: Retrospective study of all hospitalized adult patients with COVID-19 who received at least one dose of remdesivir from 11/6/2020 to 11/5/2021 at one of the Mayo Clinic hospitals. Results: Among 3,029 hospitalized patients who received treatment with remdesivir for COVID-19, the majority (89.5%) completed the recommended the five-day course. Among them, 2,169 (80%) completed treatment during hospitalization, while 542 (20.0%) patients were dismissed to complete remdesivir in outpatient infusion centers. Patients who completed the treatment in the outpatient setting had lower odds of death within 28 days (aOR 0.14, 95% CI 0.06-0.32, p<0.001). However, their rate of subsequent hospital encounters within 30 days was higher (aHR 1.88, 95% CI 1.27-2.79, p=0.002). Among patients treated with remdesivir only in the inpatient setting, the adjusted odds of death within 28 days were significantly higher among those who did not complete the 5-day course of remdesivir (aOR 2.07, 95% CI 1.45-2.95, p<0.001). Conclusions: This study describes the clinical outcomes of a strategy of transitioning remdesivir therapy from inpatient to outpatient among selected patients. Mortality was lower among patients who completed the 5-day course of remdesivir.

I n vestigating causal relationships between Asthma Phenotypes and Risks for COVID-19Shu Ran1, 2*, Xin-Hong Qiu1, Bao-Lin Liu1, 21 School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, P.R. China.2 Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, P.R. China.* CorrespondenceShu Ran, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, P.R. China.Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, P.R. China.Email: [email protected] authors contributed equally: Shu Ran and Xin-Hong Qiu.Dear Editor,We read with interest the study recently published by Lauren et al.1 They found that asthma is not a risk factor for more severe COVID-19 disease. Allergic asthmatics were protected from hospitalization with COVID-19. Lower levels of eosinophil counts were associated with a more severe COVID-19 disease trajectory. Additionally, some studies reported that the prevalence of asthma in patients with COVID-19 is lower than expected, suggesting that having asthma may be a protective effect.2 3However, inconsistent associations between asthma and COVID-19 disease have been observed in epidemiology studies.4 The causality of the association between asthma and COVID-19 has not been established. It is difficult to infer causal effects only from observational studies because of confounding. Mendelian randomization (MR) analysis is widely used to assess the presence of causal relationships between genetic variants and selected outcome and is not prone to confounding biases and reverse causality.Here, we performed MR analysis for the association of asthma phenotypes and three levels of COVID-19 to validate the authors’ findings. MR was conducted with inverse variance weighted (IVW), single-nucleotide polymorphisms (SNPs) at P < 5 × 10−8 were selected as instrumental variables. The linkage disequilibrium threshold was set to r2 = 0.001 within a distance of 10,000 kb.We used data from IEU OpenGWAS project (https://www.mrbase.org/),5developed at the MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, including information on asthma (GWAS ID: ukb-b-18113, including 53,598 cases vs. 409,335 controls), allergic diseases (GWAS ID: ebi-a-GCST005038, including 180,129 cases vs. 180,709 controls), eosinophil counts (GWAS ID: bbj-a-20, including 62,076 samples; GWAS ID: ebi-a-GCST90002301, including 8,142 samples), allergic asthma (GWAS ID: finn-b-ALLERG_ASTHMA, including 4,859 cases vs. 135,449 controls), non-allergic asthma (GWAS ID: finn-b-NONALLERG_ASTHMA, including 3,709 cases vs. 135,449 controls) and hayfever allergic rhinitis or eczema (GWAS ID: ukb-a-447, including 77,891 cases vs. 258,891 controls). Genetic association estimates for COVID-19 were obtained from release 7 of the COVID-19 Host Genetics Initiative GWAS.6 Three COVID-19 traits were selected: Covid vs. population, which included 159,840 cases versus 2,782,977 controls; Hospitalized covid vs. population, which included 44,986 cases versus 2,356,386 controls; Very severe respiratory confirmed covid vs. population, which included 18,152 cases versus 1,145,546 controls. All summary data used in this work are publicly available.The MR analyses showed that asthma was associated with decreased risk for either severe COVID-19 (OR = 0.45, 95% CI 0.22-0.91, P = 0.028) or hospitalized COVID-19 (OR = 0.56, 95% CI 0.35-0.90, P = 0.017). There were consistent evidences that higher levels of eosinophil counts could lower the risk of COVID-19 (OR = 0.94, 95% CI 0.90-0.99, P = 0.02), hospitalized COVID-19 (OR = 0.81, 95% CI 0.71-0.93 P = 3.0E-03) and severe COVID-19 (OR = 0.68, 95% CI 0.49-0.94, P = 0.022). Allergic asthma and non-allergic asthma raised the risk for COVID-19 (OR = 1.04, 95% CI 1.00-1.08, P = 0.02 for allergic asthma; OR = 1.04, 95% CI 1.00-1.08, P = 0.039 for non-allergic asthma). The MR analyses showed that hayfever allergic rhinitis or eczema could lower the risk of hospitalized COVID-19 (OR = 0.68, 95% CI 0.52-0.88, P = 3.5E-03) and severe COVID-19 (OR = 0.65, 95% CI 0.44-0.97, P = 0.034) (Table 1).In the study, we found that asthma may be a causal protective factor for the incidence of severe COVID-19 and hospitalized COVID-19. The higher levels of eosinophil counts is a protective factor for COVID-19 disease. The mechanism is not fully known, may be due to the protective effects of ongoing inflammatory responses against the of COVID-19 disease.Table 1: Mendelian Randomization Analysis Estimate of Associated between Asthma and COVID-19 Disease with Use of IVW Method.

BACKGROUND Severe acute respiratory syndrome corona virus (SARS-CoV-2) infection frequently causes severe and prolonged disease but only few specific treatments are available. We aimed to investigate safety and efficacy of a SARS-CoV-2-specific siRNA-peptide dendrimer formulation (MIR 19 ®) targeting a conserved sequence in known SARS-CoV-2 variants for treatment of COVID-19. METHODS We conducted an open-label, randomized controlled multicenter phase II trial (NCT05184127) evaluating safety and efficacy of inhaled MIR 19 ® (3.7mg and 11.1 mg/day: groups 1 and 2, respectively) in comparison with standard etiotropic drug treatment (group 3) in patients hospitalized with moderate COVID-19. The primary endpoint was the time to clinical improvement according to predefined criteria within 14 days of randomization. RESULTS Patients from group1 had a significantly reduced (median 6 days (95% confidence interval [CI]: 5-7, HR 1.75, P=0.0005) time to clinical improvement compared to patients from group 3 (8 days (95% CI: 7-10). Normalized oxygen saturation (SpO 2>94%) occurred quicker in the group 1 (median 5 days (95% CI: 4–5, HR 1.59, P=0.0033) than in the group 3 (6 days, 95% CI: 5–8). Treatment with MIR 19® was well tolerated and safe. CONCLUSIONS MIR 19 ®, a SARS-CoV-2-specific siRNA-peptide dendrimer formulation is safe and significantly reduces time to clinical improvement in hospitalized moderate COVID-19 patients compared to standard therapy in a randomized controlled trial. MIR 19 ® treatment targets a sequence which is identical in all SARS-CoV-2 variants known so far and hence should be applicable for all of them.

Introduction Pediatric oncology patients are reportedly at risk for progression to severe Coronavirus disease-2019 (COVID-19) infection. Data on the safety and clinical effectiveness of remdesivir in children with cancer remains scarce. The main aims of this study were to describe COVID-19 infection in this cohort and to evaluate the utility of remdesivir treatment in terms of the time to viral clearance and its safety profile. Methods This was a retrospective observational cohort study of pediatric oncology patients ≤18 years of age with SARS-CoV-2 polymerase chain reaction (PCR) confirmed infection. Patients were admitted to KK Women’s and Children’s Hospital from 1 st November 2021 to 31 st March 2022. Clinical data, investigations and laboratory tests results were collected. Results Eighteen patients were included. Median age was 6.5 years (IQR: 4.64 – 9.83), and there were 13 males (72.2%). The immunosuppressive status of the cohort was: severe (n = 3, 22.2%), moderate (n = 9, 50.0%) and low (5, 27.8%). All patients had mild COVID-19 infection, and there were no COVID-19 attributed deaths. Remdesivir was initiated in four patients. We did not detect any benefit in terms of time to viral clearance or SARS-CoV2 PCR cycle threshold ≥25 between the treated versus non-treated groups. Remdesivir was well tolerated with no safety concerns. Conclusion Our cohort of immunocompromised pediatric oncology patients all had mild clinical COVID-19 with no directly attributable morbidity and mortality. In four patients, treatment with remdesivir was safe but did not lead to early viral clearance.

Cough is an important symptom of numerous respiratory diseases, including COVID-19. While different cough phases (i.e., inhalation, compression, and expulsion) have been shown to be related to different pathological origins, existing cough-based COVID-19 detection systems rely on the entire cough recording, thus such phase-related characteristics are overlooked. In this study, our aim is two-fold. First, we have annotated over 1,250 cough recordings from two publicly-available cough sound databases, thus providing the research community with fine-grained cough phase labels. Next, we extract a number of temporal and acoustic features from each cough phase and test their usefulness and complementarity for COVID-19 detection. Experiments show the importance of cough phase segmentation, not only for improved COVID-19 detection, but also for the development of models that are interpretable and can better generalize across datasets.

We report two cases of previously healthy young men with COVID-19 infection who developed acute ischemic stroke due to large vessel occlusion followed by secondary events concerning for a further thromboembolic event. We hypothesize that the hypercoagulable state related to COVID-19 exacerbated the underlying hereditary thrombophilia due to MTHFR-gene mutation.

Objective: The causative virus of COVID-19 is SARS-CoV-2. The aim of the present study was to invastigate the in vivo virucidal activity of nasal irrigation with saline, nasal irrigation with Povidone-iodine (PVP-I) 1%, nasal irrigation with hypertonic alkaline and nasal irrigation with PVP-I 1% against SARS CoV- 2. Design: The present study was a prospective randomized clinical trial. Setting: A multicenter study involving tertiary care centers. Participants: The study included adult outpatients whose qualitative SARS-CoV-2 RT-PCR tests in nasopharyngeal swabs were positive. One hundred twenty patients divided into four equal groups. Standard COVID-19 treatment was given to group 1 (n=30), nasal irrigation containing isotonic solution was added to patients’ treatment in group 2 (n=30), nasal irrigation containing 1% PVP solution was added to patients’ treatment in group 3(n=30), and nasal irrigation containing 1% PVP solution and nasal irrigation containing hypertonic alkaline solution was added to patients’ treatment in group 4 (n=30). Main outcome measures: On the first day of diagnosis (day 0), nasopharyngeal swab samples were taken, on the 3rd and 5th days the nasopharyngeal viral load reduction in quantitative RT-PCR tests were calculated. Results: Between the 0-3rd Day and 0-5th days, the nasopharyngeal viral load reduction was significant in all groups (p< .05). In paired comparisons of groups, the nasopharyngeal viral load decrease in group 4 in first 3 days was significantly lower than all groups (p < .05). The nasopharyngeal viral load degrease in groups 3 and 4 in the first 5 days were significantly lower than group 1 (p < .05). Conclussion: This study was reveal that the use of hypertonic alkaline nasal irrigation together with 1% povidone-iodine was more effective in reducing viral load in the early period. The decreased nasopharyngeal viral load may reduce the carriage of infectious SARS-CoV-2 in patients. Our results suggest that 1% povidone-iodine and hypertonic alkaline nasal irrigation may be promising modality to prevent the COVID-19 epidemic.

Under the “KISA2-Tai (KANSAI Intensive Area Care Unit for SARS-Cov-2) Osaka” system, which involves a team of several medical institutions, medical care can be provided for COVID-19 patients at home at a level close to that of in-hospital care.