Since late 2021, the highly transmissible SARS-CoV-2 Omicron variant has driven a new surge of infections across the world. We used a case-ascertained study to determine the features of household transmission of SARS-CoV-2 Omicron variant in Shanghai, China. We collected detailed information on 323 pediatric cases and their 951 household members, all received consecutively intensive RT-PCR testing. We estimated the transmission parameters. Both secondary infection attack rates (SARI) and secondary clinical attack rates (SARC) among adult household contacts were computed, through which the transmission heterogeneities in infectivity and susceptibility were characterized and the vaccine effectiveness were estimated. The mean incubation period and serial interval of Omicron variant were estimated to be 4.6±2.1 days and 3.9±3.7 days. The overall SARI and SARC among adult household contacts were 77.11% (95% confidence interval [CI]: 73.58%-80.63%) and 67.03% (63.09%-70.98%). We found higher household susceptibility in females, while infectivity was not significantly different in primary cases by age, sex, vaccination status and clinical severity. Full vaccination and booster vaccination of inactivated vaccines were 14.8% (5.8%-22.9%) and 18.9% (9.0%-27.7%) effective against Omicron infection and 21.5% (10.4%-31.2%) and 24.3% (12.3%-34.7%) effective against symptomatic disease. Overall, we found high household transmission during the Omicron wave in Shanghai due to asymptomatic and pre-symptomatic transmission in the context of city-wide lockdown, indicating the importance of early detection and timely isolation of SARS-CoV-2 infections and quarantine of close contacts. Marginal effectiveness of inactivated vaccines against Omicron infection poses great challenge for prevention and control of the SARS-CoV-2 Omicron variant.

We present a case of a 16-year-old female patient who has recently been diagnosed with anorexia nervosa. Although our findings reflect one clinical case, they are consistent with new reports showing that restrictions during a pandemic situation have long-term significant adverse effects on the mental and physical health of adolescents.

Leukocytoclastic vasculitis (LCV) is a small-vessel vasculitis characterized by immune complex deposition in the walls of dermal capillaries and venules. With the COVID-19 pandemic, more adults are receiving the MMR vaccine. We report a case of MMR vaccine-related LCV occurring only on the upper extremities with associated conjunctivitis.

Coronavirus disease 2019 (COVID-19) is the most prevalent disease in society today, and vaccination is a powerful weapon against COVID-19. However, there have been many recent reports of vaccine-induced skin side effects. Autoimmune bullous reactions caused by the COVID-19 vaccine are rare. We identified a case of refractory PV associated with COVID-19 vaccination that improved after 2 RTX injections.

Introduction: In March 2020, new guidelines allowed patients with epistaxis to be discharged home with nasal packs in situ to reduce the risk of inpatient covid transmission rates. Our objective is to review how successful these new guidelines have been and whether they could be safely maintained in future practice. Methods: This was a retrospective data analysis at a local tertiary ENT referral hospital. The study group consisted of patients admitted with epistaxis over one year. The “Pack and Home” criteria pathway was implemented. We reviewed the pathway 6 months pre and 6 months post pathway introduction. Primary outcome measure included compliance with the “Pack and Home” criteria and length of inpatient admissions. Results: A total of 131 patients required nasal packing, with 72 patients (55%) in loop 1 and 59 patients (45%) in loop 2. In the first loop all 72 patients (100%) were admitted for inpatient care. However, in the second loop 21 patients (36%) were discharged home with nasal pack in situ and 59 patients (64%) were admitted. Of those discharged, 2 patients re-presented after 48 hours with re-bleeding. The average total length of inpatient stay in loop 1 was significantly higher at 45.7 hours and 29.6 hours in loop 2 (p<0.05). All discharged patients attended their outpatient appointment in under 3 days. Conclusion The “Pack and Home” criteria can successfully identify patients who are suited for an outpatient management pathway. This could reduce surgical inpatient load and the way we manage epistaxis.

We developed a deterministic model with multiple compartments by a system of differential equations, which allows for simulating novel coronavirus (COVID-19) transmission dynamics with human adaptive behaviors and vaccine effects, aiming at predicting the end time of COVID-19 infection in global scale. Based on the surveillance information (reported cases and vaccination data) between January 22, 2020 and July 18, 2022, we validated the model by MCMC fitting method. We found that (1) if without protective and control behaviors, the epidemic could sweep the world in 2022 and 2023, causing 3.098 billion of human infections, which is 5.39 times of the current number; (2) there could be 645 million people avoided from infection due to vaccine; (3) if following current scenarios of protective/control behaviors and vaccine rate, the cumulative number of cases would increase slowly, leveling off around 2023, and the epidemic would end completely in June 2025, causing 1.024 billion infections. Our findings suggest that collective protection behavior and vaccination remain the key determinants of the global process of COVID-19 transmission.

Background: Epistaxis management frequently includes the insertion of a non-absorbable nasal pack, and patients may often be admitted during this treatment. During the recent COVID-19 pandemic, UK guidance to discharge “suitable” patients, with pack in-situ, was published in order to minimise hospital admissions and viral nosocomial transmission. Evidence which defines patient suitability for discharge, however, is lacking. Method: The medical records of 100 patients admitted for idiopathic epistaxis in our trust, managed with non-absorbable packing, were analysed. We sought to determine whether risk factors for re-bleeding through packs, or for haemorrhage-related complications, for which inpatient admission would allow more timely treatment, could be identified. Patient factors and outcomes were correlated using binomial logistic regression. Results: 13 patients re-bled through nasal packing. Statistically significant (1 tailed, P<0.05) predictors of bleeding despite packing were male sex, hypertension diagnosis, and aspirin use, with younger patients being at a modestly increased risk. Warfarin or direct oral anticoagulant (DOAC) use was not associated with increased bleeding risk. Conclusion: This study provides initial evidence of factors that affect the risk of bleeding through packs, and which patients may require inpatient care when packed. We recommend a future multicentre study with larger recruitment numbers to expand upon this pilot study’s results.

COVID-19 can lead to pneumonia or acute respiratory distress syndrome. Non-respiratory manifestations of COVID-19 include venous and arterial thrombosis. The disease can affect kidneys and lead to renal vein thrombosis leading to symptoms such as flank pain, hematuria, or acute kidney damage.

Background: Cancer patients are a particularly vulnerable risk group of the severe course of COVID-19 due to, i.e. suppression of the immune system. The study aimed to find links between parameters registered on admission to the hospital, and the risk of latter death in oncology patients with COVID-19. Design: Retrospective cohort study. Methods: The study included patients with a reported history of malignant tumor (N=151) and the control group with no history of cancer (N=151) hospitalized due to COVID-19 between March 2020 and August 2021. The variables registered on admission were divided into categories for which we calculated the multivariate Cox proportional hazards models. Results: The median age of the study group was 68 years (min-max: 17-95). 50.33% (76/151) were women. Multivariate Cox proportional hazards models were successfully obtained for the following categories: Patient data, Comorbidities, Signs recorded on admission, Medications used before hospitalization and Laboratory results recorded on admission. With the models developed for oncology patients, we identified the following variables that registered on patients’ admission were linked to significantly increased risk of death: male sex, presence of metastases in neoplastic disease, impaired consciousness (somnolence or confusion), wheezes/rhonchi, the levels of white blood cells and neutrophiles. Conclusion: Identifying the predictors of a poorer prognosis may serve clinicians in better tailoring treatment among cancer patients with COVID-19. Our results can help develop prognostic models or compare the results of other studies, which will translate into better treatment management and better prognosis in this group of patients.

Background: Acute lower respiratory tract infections (ALRI) are one leading cause of morbidity and mortality among people of all ages worldwide, particularly in low- and middle-income countries (LMICs). The purpose of this study was to determine epidemiological characteristics of respiratory viruses in ARI patients during the SARS-CoV-2 pandemic in Yaoundé, Cameroon. Methods: Patients were monitored for respiratory symptoms as part of surveillance of SARS-CoV-2 and other respiratory viral infections. Patients of all ages with respiratory symptoms less than 5 days were considered. Sociodemographic and clinical data as well as nasopharyngeal samples was collected from patients. Nasopharyngeal samples were tested for SARS-CoV-2, Influenza and Respiratory Syncytial Virus (RSV) using real-time reverse-transcription polymerase chain reaction methods. Virus distribution and demographic data were analyzed with R version 2.15.1. Results: From July 2020 to October 2021, 1120 patients were included. The overall viral detection rate was 32.5%, including 9.5 % for RSV (Respiratory Syncytial Virus), 12.6 % for influenza virus and 12.8 % for SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2). Co-infections were detected in 6.9% of positive cases. While RSV and influenza virus showed seasonal trends, SARS-CoV-2 was detected throughout the study period. Conclusion: We found that during SARS-CoV-2 pandemic, respiratory viruses play an important role in aetiology of influenza-like illness in Cameroon, and this observation was true for patients of all ages.

Vulnerable patient populations have seen decreased rates of vaccination against SARS-CoV2 (COVID-19) due to hesitancies and distrust, magnified by a paucity of data for certain populations. The rates of COVID-19 vaccination in children with Sickle Cell Disease (SCD) remains low despite the risk for severe complications, resulting in continued infections and hospitalizations from COVID-19. We sought to describe vaccine reactions including vaso-occlusive crises, emergency department visits, and hospitalizations in children with SCD. Our findings will start to provide the necessary vaccine side effect data to inform patients, caregivers, and clinicians considering the COVID-19 primary vaccination series.

Background and Purpose Uncontrollable inflammation has been the leading cause of mortality in many acute respiratory infections, including influenza. In light of the current COVID-19 pandemic, it is vital to develop valid therapeutics or supplements that are effective in suppressing lung inflammation. Feruloylated oligosaccharides (FOs) is a phytochemical constituent that exerts anti-inflammatory activities. Experimental Approach We established the influenza-induced lung inflammation model by infecting C57BL/6J mice or MAVS knockout (Mavstm1Zjc/J) mice with influenza A virus (H1N1). Lung index, histology analysis, hemagglutination inhibition assay as well as neuraminidase inhibition assay were performed to evaluate the therapeutic effect of FA and FOs. PCR, western blot, docking simulation and metabolomics were done to elucidate the mechanism of FOs anti-inflammatory function in lung. Key Results Herein, we found that oral administration of FOs moderately inhibited H1N1 virus infection and reduced lung inflammation in influenza-infected mice by decreasing a wide spectrum of cytokines in the lungs. FOs also suppressed transduction of the RIG-I/MAVS/TRAF3 signaling pathway and lowered the expression of NF-κB. Moreover, we found that the anti-inflammatory function of FOs against influenza depends on MAVS, which is closely associated with activation of the downstream signaling cascades and the eventual production of pro-inflammatory cytokines and type I interferons. Conclusions and Implications In conclusion, we demonstrated that FOs is an effective anti-inflammatory agent for treating the lung inflammation caused by influenza. Such therapeutic effect was likely mediated by RIG-I/MAVS/TRAF signaling.

Objective Examine experiences of termination of pregnancy (TOP) in South Australia to recommend areas for service improvement following decriminalisation legislation. Design Qualitative case study. Setting Online semi-structured interview. Participants The case study was an example of the unheard, complex and distressing circumstance of TOP due to fetal anomaly diagnosis. The case was selected from larger sample (N=8) of adults who had recently had a TOP in South Australia as a subgroup from a larger study looking at the potential missed opportunities of health professionals to provide access to contraception prior to abortion. Methods Semi-structured, in depth, qualitative interview. Qualitative description using thematic content analysis identified significant aspects of the participant’s story pertaining to potential health service improvements. Results The participant experienced trauma navigating a difficult care pathway following a diagnosis of fetal anomaly. They described inadequacy of labels for pregnancy such as planned, unplanned, wanted, unwanted, the framing of abortion through the lens of ‘choice’, and confusion about service referrals and inappropriate communication by health professionals. Not being able to have a partner accompany her through the process of having a TOP due to COVID-19 restrictions resulted in extreme distress. Conclusion Abortion services need clear care pathways that are context specific, and patient centred. The language and attitudes of health professionals can result in distressing experiences of TOP. Further investigation of the relationship between infection control strategies and trauma in health service provision is warranted to improve future pandemic responses.

A document by Raquel Valdes Angues. Click on the document to view its contents.

Aim: Interferons (IFNs) have been identified as a potential treatment alternative for Coronavirus Disease 19 (COVID-19). This study assessed the safety, tolerability, bioavailability, and biological activity of inhaled interferon-α2b (IFN-α2b) in healthy adults. Methods: A double-blind, randomized, phase 1 clinical trial was conducted with two cohorts of healthy subjects aged 18-50 years old. The first cohort received 2.5 MIU of inhaled IFN-α2b twice daily for 10 days (n=6) or placebo (n=3); the second cohort received 5.0 MIU of inhaled IFN-α2b in a similar scheme (n=6) or placebo (n=3). The first two doses were administered in an Emergency Department, then participants completed their treatment at home. Safety was measured through vital signs, new symptoms, and laboratory tests. Tolerability was measured as the participant´s treatment acceptability. Bioavailability and biological activity were measured from serum IFNα levels and real-time quantitative PCR of interferon-induced genes in blood before and after treatments. Results: Exposure to inhaled IFN-α2b at 2.5 MIU or 5 MIU doses did not produce significant changes in participant vital signs, or elicit new symptoms, and standard hematological and biochemical blood measurements were comparable to those recorded in individuals who received placebo. All adverse events were mild or moderate and did not require medical care. Participants reported very high tolerability. A dose-dependent mild increase in serum IFN-α concentrations and an increase in serum RNA expression of IFN-induced genes were observed after treatment. Conclusion: Inhaled IFN-α2b was safe, well-tolerated, and induced systemic biological activity in healthy subjects.

TITLE PAGE Title: Letter to the Editor: Early experience of aortic surgery during the COVID-19 pandemic in the United Kingdom: A multicenter studyArticle type: Letter to the editorCorrespondence : 1. Sara AlzagloolContact: +962797244907 Email: Sarah97.zg@hotmail.comInstitute: Al-Bashir HospitalAddress: Al Bashir Hospital، Ossamah Ben Zeid St. 261, Amman, JordanCo-authors : 2. Osama Al-JaiuossiContact: +962788003306 Email: Osamaeyad@ymail.comInstitute: Al-Bashir HospitalAddress: Al Bashir Hospital، Ossamah Ben Zeid St. 261, Amman, JordanWords count: 480Conflict of interest: NoneFunding: NoneAcknowledgement: NoneDeclaration: None

SARS-CoV-2-Triggered Hemophagocytic Lymphohistiocytosis with Complications of Posterior Reversible Encephalopathy SyndromeRoss M. Perry, M.D. a* | Scott D. Casey, M.D., M.S. b | Alex Q. Lee, M.D.a | Sylvia P. Bowditch, M.D.c | Mary A. Rasmussen, M.D.c | Viyeka Sethi, M.D. d| Arun R. Panigrahi, M.D. eaUniversity of California, Davis, School of Medicine, Sacramento, California, USA; bDepartment of Emergency Medicine, University of California, Davis, Sacramento, California, U.S.A.; cDepartment of Pediatrics, University of California, Davis, Sacramento, California, U.S.A;dDepartment of Pediatric Critical Care Medicine, University of California, Davis, Sacramento, California, U.S.A;eDepartment of Pediatric Hematology & Oncology, University of California, Davis, Sacramento, California, U.S.A*Correspondence to:Ross Perry, M.D., 14 Rock Lane, Berkeley, CA, 94708, Phone: (707) 331-4626, Fax: (510) 752-1571, E-mail: rossmperry@gmail.comMain Text Word Count: 850Tables: 1; Figures: 1Short Title: SARS-CoV-2-Triggered HLH Complicated by PRESKeywords: SARS-CoV-2, HLH, PRES, MIS-C, corticosteroids, anakinra

The European Medicines Agency (EMA) started operating under its new legal mandate on 1 April 2022. The mandate brings new responsibilities to the Agency in three different areas: • Reinforcement of the role and activities of the EMA pandemic Task Force(which is now known as the Emergency Task Force (ETF)). • A stronger role of EMA in the monitoring of shortages of critical medicines, medical devices and in-vitro diagnostics, both in anticipation of and during a crisis. • A more coordinated mechanism of European Union (EU) experts advice on medical devices classified as high-risk (class IIa and III or class D (1)) and in-vitro diagnostic medical devices. Here we consider the impact of the COVID-19 pandemic on the operations of EMA and the European medicines regulatory network, and how EMA’s new mandate will strengthen the Agency’s and the Network’s ability to face crises. EMA’s extended mandate brings clear benefits in terms of response to public health emergencies at EU level, which ranges from improvements in crisis management to avoiding medicine shortages and improving access to diagnostics and medical devices that are safe and conform to their expected function.

Chinese COVID-19 vaccine named BBIBP-CorV (Sinopharm vaccine) is an inactivated whole virus vaccine to prevent COVID-19 disease. Previous studies concluded that inactivated COVID-19 vaccines do not increase the risk of thrombosis. In this report, we present the first upper limb DVT case after receiving this kind of vaccine.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19. COVID-19 has shown syndromic complexity. COVID-19 effects on the respiratory system have been well described in the literature, but we now recognize that COVID-19 also affects several other organs, including the nervous system. The neurological manifestations of SARS-CoV-2 infection are growing rapidly, as evidenced by several reports. There are several mechanisms responsible for such manifestations in the nervous system. For instance, post-infectious immune-mediated processes, direct virus infection of the central nervous system (CNS), and virus-induced hyper-inflammatory and hypercoagulable states are commonly involved. Due to multifactorial and complicated pathogenic mechanisms, COVID-19 poses a large-scale threat to the whole nervous system. A complete understanding of SARS-CoV-2 neurological impairments is still lacking, but our knowledge base is rapidly expanding. Therefore, we anticipate that this comprehensive review will provide valuable insights in unfolding different neurological dimensions of COVID-19 and other CoV associated abnormalities.

Background Intra-host diversity studies are used to characterise mutational heterogeneity of SARS-CoV-2 infections to understand the impact of virus-host adaptations. This study investigated the frequency and diversity of the spike (S) protein mutations within SARS-CoV-2 infected South African individuals. Methods Single nucleotide polymorphism (SNP) assays and whole genome sequencing were performed on SARS-CoV-2 positive samples. Allele frequency (AF) was determined using TaqMan Genotyper software for SNP analysis and galaxy.eu for analysis of FASTQ reads. Results The SNP assays identified 5.3% (50/948) Delta cases with heterogeneity at delY144 (4%; 2/50), E484Q (6%; 3/50), N501Y (2%; 1/50) and P681H (88%; 44/50). Sequencing identified 9% (210/2381) cases with Beta, Delta, Omicron BA.1, BA.2.15, and BA.4 lineages with heterogeneity in the S protein. Heterogeneity was primarily identified at positions 19 (1.4%) with T19IR (AF 0.2-0.7), 371 (92.3%) with S371FP (AF 0.1-1.0), and 484 (1.9%) with E484AK (0.2-0.7), E484AQ (AF 0.4-0.5) and E484KQ (AF 0.1-0.4). Conclusion Mutations at heterozygous amino acid positions 19, 371 and 484 reduce recognition of neutralising antibodies, however the impact of the multiple substitutions at the same position is unknown. Therefore, we hypothesise that intra-host SARS-CoV-2 quasispecies with heterogeneity in the S protein facilitate competitive advantage of variants that can completely/partially evade host’s natural and vaccine-induced immune responses.

Objective Assess whether coronavirus disease 2019 (COVID-19) vaccination impacts menstrual bleeding quantity. Design Retrospective cohort Setting Five global regions Populations Vaccinated and unvaccinated regularly cycling individuals using the digital fertility-awareness application “Natural Cycles”. Methods We used prospectively collected menstrual cycle data and multivariable longitudinal Poisson GEE models, multivariable multinomial logistic regression models, and calculated the adjusted difference between vaccination groups. All regression models were adjusted for confounders. Outcome measures Mean number of heavy bleeding days (fewer, no change, more) and changes in bleeding quantity (less, no change, more) at three time points (first dose, second dose, and post-exposure menses). Results We included 9,555 individuals (7,401 vaccinated, 2,154 unvaccinated). About 2/3 of individuals reported no change in the number of heavy bleeding days regardless of vaccination status. After adjusting for confounders, there were no significant differences in the number of heavy bleeding days by vaccination status. A larger proportion of vaccinated individuals experienced an increase in total bleeding quantity (34.5% unvaccinated, 38.4% vaccinated; 4.0% [0.7, 7.2%] adjusted difference). This translates to an estimated 40 additional people per 1,000 normally cycling individuals who experience more total bleeding quantity following the first vaccine dose due to vaccination. Differences resolved in the cycle post-exposure. Conclusion A small increase in the probability of more total bleeding quantity occurs following the first COVID-19 vaccine dose which resolved the cycle post-vaccination cycle. Total number of heavy bleeding days did not differ by vaccination status. Our findings can reassure the public that any changes are small and transie

A document by Alessandro Farsi. Click on the document to view its contents.

The present work argues the involvement of zinc chelation ability of some non-steroidal anti-inflammatory drugs as an additive mechanism able to increase their efficacy against COVID-19.