Background: A new one SARS-CoV-2 Variant of Concern (VoC), Omicron, was born in a world weary of COVID-19, which anger and frustration with the pandemic was widespread, with wide-ranging negative impacts on health, social and economic well-being. The Omicron variant, which main types was BA5.2and BF.7 in China, in December 2022 to January 2023 leaded to off-target of the S and N genes, and the kits used were not adequately and independently evaluated when these agents are studied and developed. To ensure the accuracy of coronavirus test results, performance verification of commercial Real-Time quantitative PCR (RT-qPCR) was required. Objective: We performed a clinical evaluation for two Real Time SARS-CoV-2 assay, and to verify them based on different detection reagents and different clinical specimens. Methods: We performed clinical evaluations of two existing Chinese SARS-CoV-2 RT-qPCR kits COVID-19 nucleic acid detection kits (e-Diagnostic Biomedical, Wuhan, China) and 2019-nCoV nucleic acid diagnostic kits (Fosun Biotechnology, Shanghai, China) using BSD ( Bondson) (Guangzhou Bondson Biotechnology Co. Ltd.;batch number 2022101), quality controls provided by the inspection center and a large number of clinically confirmed specimens. Overall, through the BDS performance verification reference product kit, It was best used to verify the performance of the reagent through a large number of clinical specimens for further verification. Results: The coincidence rate for Fosun and e-Diagnostic kits were individually 95% and 100%. Verified that the detection limit for Fosun and e-Diagnostic kits was 300copies/mL. All were below the detection limit for Fosun reagent was 300copies/mL. e-Diagnostic was 500copies/mL. Fosun had the largest CV for ORF1ab and N gene at the the detection limit concentration(4.80%,3.49%), while e-Diagnostic had the smaller (0.93%,1.10%). Negative results were tested in cross-reactivity. During the verification of clinical samples, sequencing analyses had shown that Fosun single gene miss rate was relatively high, especially ORF1ab, followed by N gene miss rate. we survey that all N genes were detected in clinical specimens, ,ORFab dropout (i.e., a negative/low result) occurred in (10.8%) of 225 Omicron variant. Conclusions: Our results endorse the use of these two commercial kits for the diagnosis of SARS-CoV-2 in China, as their clinical performance has been fully validated by a large number of clinically confirmed cases.

Purpose: This study examines which vaccination organization system performed best in the COVID-19 pandemic to improve future vaccination organization. Study design: The vaccination organization of every federal state is categorized as decentralized or centralized and analysed based on their daily vaccination rates and the vaccination time series of the federal state with the highest vaccination rate is analysed by using the Event Study Methodology [ESM]. Findings: In Germany’s federal state with the highest vaccination rate (i.e., Saarland), the change from a system of availability-based offerings to a pre-registration with preferences and automatic appointment allocation system was a significant performance factor. Originality: A quasi-experimental study with a different vaccination organization is setup and the Event Study Methodology [ESM] is applied to the vaccination context. Research limitations: This study is limited on the vaccination organization of high-developped countries with a comprehensive health system such as Germany. Practical implications: A pre-registration and automatic appointment allocation system is recommended as best practice to policy makers and pandemic managers for their vaccination organization given the first half-year experience in the COVID-19 pandemic. Social implications: A cumulative additional vaccination rate of 8.44 per 100 inhabitants and an 14% overperformance is found. The implementation of this system for whole Germany would have resulted in 4% higher protection, estimated 26’596 less infections, US$ 7 million less hospitalization costs, and earlier relaxation of lockdown of two months.

The number of SARS-CoV-2 recombinants identified during the pandemic has increased since the era of Omicron variants, but XBB.1.5 (or Omicron 23A) is the first lineage comprised of hybrid genomes to predominate at the country and global scales. Very interestingly, the XBB.1.5 recombinant, like the Marseille-4B subvariant (B.1.160/20A.EU2) and the pandemic variant B.1.1.7 (20I/Alpha) previously, has its ORF8 gene inactivated by a stop codon. XBB.1.5 was generated through two successive main events: a recombination between SARS-CoV-2 of lineages BA.2.10.1.1 (BJ.1) and BA.2 75.3.1.1.1 (BM.1.1.1) that generated the XBB (22F) lineage; then ORF8 gene inactivation by a stop codon. We further identified that a stop codon was present at 89 (74%) codons of the ORF8 gene in ≥1 of 15,222,404 genomes available in GISAID, and at 15 codons (12%) in ≥1,000 genomes. Thus, it is very likely that stop codons in ORF8 gene contributed on at least 3 occasions and independently during the SARS-CoV-2 pandemic to the evolutionary success of a lineage that became transiently predominant, most recently XBB.1.5. Such association of gene loss with evolutionary success, which suits the recently described Mistigri rule, is an important biological phenomenon very unknown in virology while largely described in cellular organisms.

Objective: The accuracy of clinical coding in COVID-19 is essential for quality of care, disease surveillance, as well as research and reporting. This study aims to describe and categorize consultations between medical coders based on the social media network in Iran on the COVID-19 coding. Method: A clinical coding group in the social network at the national level in Iran was established to follow consultation regarding COVID-19 among coders. We also utilized an online survey, which was designed to extract the problems coders encountered during clinical coding and their opinion on whether these consultations were effective. Herein, we report messages and communication records exchanged among members of this network obtained between 21 February 2020 and 20 November 2020. Finally, we categorised the obtained information and identified the problems for COVID-19 accurate coding in Iran. Results: A total of 1,340 messages in 332 consultations were exchanged amongst 76 coders. We categorised topics of consultations into 11 categories. Most consultations dealt with “suspected or probable” (n = 71), “clinical coding and diagnosis” (n=59) within 332 conversations. In 47% of consultations, the first reply was less than 10 ± 3 min. “Maternal and infant ” and “procedures and drugs ” were the most common subjects with specific answer. Based on the viewpoints of coders, online consultations can reduce the time of clinical coding and increase coding accuracy. Conclusion: The establishment of social networks among medical record coders is an efficient strategy to deal with coding issues during the COVID-19 pandemic and improve the quality of hospital records.

Over the past few decades, researchers have paid more focus to finding the optimal method for controlling infectious diseases. Recently, the idea of optimal control has widely been used to discuss the spread of COVD-19 pandemic. In this article, we consider a mathematical model to show the transmission of this virus with constant rates. Then, the optimal control technique is applied on the model with two different scenarios. The first scenario contains two different controls such as treatment and vaccination rate. However, the second scenario is dealing with treatment and vaccination effect. Accordingly, this study identifies the impact of these control mechanisms as time-dependent interventions using mathematical modeling and an optimal control method with Hamilton technique and Pontryagin's maximum principle. Computational results show that the use of treatment in the high level has the biggest impact in the minimizing the total infected people. Furthermore, the suggested mathematical model with and without control variables are accurately analyzed using the forward-backward Runge Kutta method in MATLAB for initial states and parameters. The findings of optimal control here indicate that the suggested scenarios may effective use for reducing the number of infected individuals and improving public health strategies more widely.

Pathogen spectrum of Hand, foot and mouth disease (HFMD) has substantially changed in the past decade. How do the co-circulating pathogens interact and the coronavirus disease 2019 (COVID-19) intervene the incidence of HFMD remain unclear. Here, we evaluated the virus-virus interaction (VVI) of EVs using Spearman’s Correlation in Nanchang, China. And the impact of COVID-19 intervention on HFMD incidence was estimated using seasonal autoregressive integrated moving average (ARIMA) models. Enterovirus (EV) serotypes were determined by RT-PCR. From 2019 to 2022, 1321 (57.5%) out of 2296 HFMD cases were EV-positive, in which coxsackievirus A6 (CVA6) and CVA16 were the major pathogens, accounting for 34.0%-59.6% and 14.9%-31.4%, respectively. Our analyses provide strong statistical support for the existence of VVIs among enteroviruses, in which CVA6 negatively interacted with CVA16 and EV-A71, and positive VVI between CVA16 and EV-A71 was observed. While CVA6 has a (albeit inconsistent) seasonal pattern in Nanchang, typically peaking in fall-winter months before COVID-19 epidemic, CVA16 and EV-A71 contemporaneously peaks around May, supporting the epidemiological VVIs among these strains. During the COVID-19 epidemic, the seasonal HFMD epidemic peak was restrained, indicating the COVID-19 intervention had mitigated EV transmission. Moreover, we first figured out the serotypes from other enteroviruses, among them CVA4, CVA2, CVA5 and CVB3 were the major agents accounting for 34.8%, 23.9%, 23.9% and 10.9%, respectively. Taken together, CVA6 and CVA16 were currently the most predominant pathogens negatively interacted with each other in Nanchang, while NPIs of COVID-19 outbreaks interfered the interactions by mitigating their incidence and transmission.

Kidney injury is common in patients with Coronavirus Disease-19 (COVID-19). In this study, 49 patients with Omicron associated kidney injury were included, 38 of whomperformed renal biopsy. Patients were divided into 2 groups: Group A for patients developing kidney injury afterSARS-CoV-2 infection and Group B for patients with aggravated renal insufficiency after SARS-CoV-2 infection. The clinical, pathological and prognostic characteristicsof the patients and theirC3 levels were observed.In our center, the clinical diagnoses of patients with COVID-19 associated kidney injury were mainly acute kidney injury(AKI), chronic kidney disease(CKD) and nephrotic syndrome(NS); while the pathological diagnoses were mainly IgA nephropathy(IgAN)、focal segmental glomerulosclerosis(FSGS) and membranous nephritis(MN).80% of COVID-19 associated nephropathy (COVAN) patients had normal serum C3 complement level, and a few patients had increased or decreased C3 level. In renal tissue, C3 deposits were observed in 68.4% of patients.29% of patients experienced deterioration of renal function after treatment, but no patients developed to end-stage renal disease (ESRD). Among all of them, one case presenting with thrombotic microangiopathy (TMA) had a more severe renal pathological lesion and poorer prognosis. We observed differences of clinical and pathological features of patients with COVID-19associated kidney injury between races, regions and virus variants. Asian patients with Omicron associated kidney injury have milder kidney injury and a better renal prognosis.

A document by zahra saadatian. Click on the document to view its contents.

Background. Discharge against medical advice (DAMA) is used in healthcare facilities in a situation where patients refuse care or decide to leave the hospital before the treating physician recommends discharge. Previous studies have found DAMA to be prevalent among patients with various chronic conditions. The study had four objectives. The study aimed to investigate: 1) the prevalence of DAMA during COVID-19 (2020-2021) among Jordanian patients with chronic diseases, 2) the association between DAMA and sociodemographic and clinical characteristics of patients with chronic diseases, 3) the predictors of DAMA, and 4) the reasons behind DAMA at the patient, hospital, and environmental levels. Methods. A descriptive cross-sectional correlational design was used in the study. A convenience sampling approach was used to collect data from 1576 patients with chronic diseases from 3 private hospitals. Results. The study found that the prevalence rate of DAMA was 33.3%. There was a significant association between the sociodemographic and clinical characteristics of patients with chronic diseases and DAMA. Health insurance found to be the strongest predictor of DAMA. Finally, the study found that patient, hospital, and environmental- related factors had a low impact on DAMA. Conclusions: DAMA is prevalent among patients with chronic diseases in Jordan during COVID-19 pandemic. The current study’s findings can serve as an empirical basis for planning and implementing DAMA prevention programs and/or establishing or revising policies for the target population.

Background: In Angola, COVID-19 cases have been reported in all provinces, resulting in >105,000 cases and >1,900 deaths. However, no detailed genomic surveillance into the introduction and spread of the SARS-CoV-2 virus has been conducted in Angola. We aimed to investigate the emergence, and epidemic progression during the peak of the COVID-19 pandemic in Angola. Methods: We generated 1,210 whole-genome SARS-CoV-2 sequences, contributing West African data to the global context, that were phylogenetically compared against global strains. Viral movement events were inferred using ancestral state reconstruction. Results: The epidemic in Angola was marked by four distinct waves of infection, dominated by 12 viral lineages, including VOCs, VOIs, and the VUM C.16, which was unique to Southwestern Africa and circulated for an extended period within the region. Viral exchanges occurred between Angola and its neighboring countries, and strong links with Brazil and Portugal reflected the historical and cultural ties shared between these countries. The first case likely originated from southern Africa. Conclusion: A lack of a robust genome surveillance network and strong dependence on out-of-country sequencing limit real-time data generation to achieve timely disease outbreak responses, which remains of the utmost importance to mitigate future disease outbreaks in Angola.

Recent studies have demonstrated the effectiveness of hybrid SARS-CoV-2 vaccines that combine the wild-type nucleocapsid (N) and Spike (S) proteins. Based on this strategy, we have further enhanced the idea by incorporating the spike protein with mutations from delta and post-delta omicron variants of concern (VOC). Both delta and omicron mark the transition of vaccine driven viral immunity and resistance, so their mutations are highly crucial for future viral variants also. Additionally, we have included certain nucleocapsid peptides, which have clinically shown superior T-cell immunity being similar to homologous sequences from other Human Coronaviruses (HuCoV). We have also carefully selected an envelope peptide that elicits strong T-cell immune response. These peptides are clustered in the hybrid spike’s cytoplasmic region with non-immunogenic helical linkers, enabling systematic arrangement. Through AlphaFold analysis, we have determined that the resulting domain folds more efficiently when the construct lacks the transmembrane domain. The AlphaFold designs were validated using the molecular dynamics (MD) simulations and assessed various parameters of root mean square deviation (RMSD), root mean square fluctuation (RMSF), radius of gyration (Rg) and weighed the structural stability and conformational dynamics. Interestingly, the dynamics revealed more insights into the conformational changes in the structure overtime, more flexibility in the C-terminus region, and overall compactness of the structures in a time-based gradient indicating less fluctuation and transition in terms of structure mobility and maintained a relatively compact fold conformation throughout the simulation. Our proposed approach may provide option for incorporating diverse anti-viral T-cell peptides, similar to HuCoV, into linker regions, offering a versatile solution to address outbreaks and challenges posed by various viruses, thereby enabling effective management through multiepitope strategies in this era of innovative vaccines.

Pulmonary fibrosis, profound alveolitis, and the failure to restore alveolar epithelial architecture are major causes of respiratory failure in fatal COVID-19. However, contributing factors to abnormal fibrosis in critically ill COVID-19 patients are yet to be understood. This study analyzed the histopathology of lung autopsy samples from eight COVID-19 and six non-COVID-19 post-mortems. The distribution and changes in extracellular matrix (ECM) proteins, including elastin and collagen in lung alveoli, were quantitatively assessed through morphometric analyses. These studies reveal massive degradation of elastin fibers along the thin-alveolar walls of the lung parenchyma that supersedes interstitial collagenous fibrosis and intra-alveolar fibrotic abnormalities. Injured lungs with collapsed alveoli and organized fibrotic regions exhibited widespread elastolysis. Further, immunoblotting of lung autopsy extracts validated extensive elastin degradation. Importantly, loss of elastin was correlated with induction of neutrophil elastase (NE), a potent protease that degrades ECM, and increased staining of peptidylarginine deiminase, a marker for neutrophil extracellular traps release, and extensive epithelial necrosis. Further, elevated plasma levels of NE-alpha1-antitrypsin complex in hospitalized COVID-19 patients indicate dysregulated neutrophil activity. These findings place elastin degradation at the center of alveolar structural disintegration and argue that elastolysis and alveolitis lead to abnormal ECM repair and fibrosis in fatal COVID-19.

SARS-CoV-2 has had a significant impact on pregnancy outcomes due to the effects of the virus and the altered healthcare environment. Stillbirth has been relatively hidden during the COVID-19 pandemic, but a clear link between SARS-CoV-2 and poor fetal outcome emerged in the Alpha and Delta waves. A small minority of women/birthing people who contracted COVID-19 developed SARS-CoV-2 placentitis. In many reported cases this was linked to intrauterine fetal death, although there are cases of delivery just before imminent fetal demise and we shall discuss how some cases are sub-clinical. What is surprising, is that SARS-CoV-2 placentitis is often not associated with severe maternal COVID-19 infection, and this makes it difficult to predict. The worst outcomes seem to be with diffuse placental disease and occurs within 21 days of COVID-19 diagnosis. Poor outcomes are often pre-dated by reduced fetal movements, but are not associated with ultrasound changes. In some cases, there has also been maternal thrombocytopenia, or coagulation abnormalities, which may provide a clue as to which pregnancies are at risk of fetal demise if a further variant of concern is to emerge. In future, multidisciplinary collaboration and cross-boundary working must be prioritised, to quickly identify such a phenomenon and provide clinicians with clear guidance for reducing fetal death and associated poor outcomes. Whilst we wait to see if COVID-19 brings a future variant of concern, we must focus on appropriate future management of women who have had SARS-CoV-2 placentitis. The histopathology reports with pathologies of chronic histiocytic villositis and/or massive perivillous fibrin deposition fill clinicians with concern about future pregnancy outcomes. However, we must remember, that in the context of a cause (SARS-CoV-2) and no other history of concern, it is not likely that SARS-CoV-placentitis will recur, and thus a measured approach to subsequent pregnancy management is needed.

A document by Pradip Jana. Click on the document to view its contents.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a systemic infection that ranges from asymptomatic to severe respiratory tract infections and influenza-like illness to severe disease with respiratory failure from acute respiratory distress syndrome (ARDS). The leading cause of mortality for SARS-CoV-2 is respiratory failure from ARDS. This study aimed to summarize the clinical outcomes of severe acute respiratory infection produced by SARS-CoV-2 in 293 Colombian adults. This retrospective study analyzed the clinical outcomes of severe acute respiratory infection produced by SARS-CoV-2 in 293 Colombian adults. The study collected data on age, clinical manifestations, comorbidities, radiological findings, and fatal cases. It was found that patients over 60 years old (53%) suffered the most severe symptoms, with frequent clinical manifestations of dyspnea (60.6%), cough (46.3%), and changes in osmotic diuresis (29.3%). About 55.3% of the patients had comorbidities, where cardiovascular disease (54.9%) was the most frequent coexisting condition. Regarding radiological findings, alveolar infiltrate and ground glass opacifications had the biggest frequency (58.9% and 40.7%, respectively). Fatal cases detected were 45.4%, where patients over 60 years (66.2%) were severely affected, however, adults from 40-59 years had a 27.8% mortality rate. Tachycardia and elevated serum biomarkers -ureic nitrogen, creatinine, D-dimer, troponin, LDH, AST, and ALT levels- were significantly more frequent in fatal cases compared to non-fatal patients. In conclusion, this study showed the clinical spectrum of severe acute respiratory infection produced by SARS-CoV-2 in Colombian adults, which is still having an active circulation and causing severe or fatal outcomes.

A document by yongchi ma. Click on the document to view its contents.

Title: Granulomatosis with Polyangiitis Mimicking COVID-19 Pneumonia: A Case Report

Background: Neonatal diseases are a significant threat to global public health, resulting in the disturbance of normal homeostatic well-being in affected patients and reflecting the status of, and challenges to, regional, national, and global healthcare systems. Objectives: To investigate the disease spectrum observed among neonatal inpatients changed after COVID-19 breakout. Methods: The present hospital-based retrospective study analyzed the demographic and clinical characteristics of 19,943 newborns who were hospitalized from January 2018 to December 2022 using data derived from pediatric department registers. Results: According to the ICD-11 classification criteria, the two most common neonatal disorders during this study period were “Certain conditions originating in the perinatal period” and “Disease of the respiratory system”. Following the start of the COVID-19 pandemic, the number of neonatal patients declined markedly, and the proportion of newborns assigned the “Disease of the respiratory system” ICD-11 classification similarly decreased. Discusssion and Conclusions: The present study retrospectively analyzed these neonatal disease characteristics at our hospital in greater detail, providing a foundation for future research and policymaking efforts.

A document by I VERN LIM. Click on the document to view its contents.

Background: The role of allergy as risk factor for Long-COVID (LC) is unclear. We aimed to systematically review and appraise the epidemiological evidence on allergic diseases as risk factors for LC (PROSPERO: CRD42023391245). Methods: We examined literature for prospective cohort studies with a follow-up duration of 12 months for LC symptoms, published within the timeframe from January 2020 and January 2023 that recruited individuals with confirmed SARS-CoV-2 infection and information on pre-existing allergic diseases. Risk of bias and certainty of evidence were assessed (GRADE). Random effects meta-analyses were used to pool unadjusted ORs within homogeneous data subsets. Results: We identified 13 studies (participants range = 39 - 1,950), all of which were associated with high risk of bias. Four of these studies did not provide data to calculate ORs. Significant associations were observed between increased LC incidences and pre-existing asthma measured in hospital-based populations ( n = 6) and pre-existing rhinitis ( n = 3) ( OR = 1.94; 95% CI [1.08, 3.50]; OR = 1.96; 95% CI [1.61, 2.39]), respectively. However, the level of certainty regarding these exposure outcome associations was very low. Conclusion: Findings show that allergies may increase the risk of LC, although the reliability of this evidence is tenuous.

Manuscript category: Letters to the EditorTitle: New-onset bullous pemphigoid after SARS-CoV-2 infectionKeywords: COVID-19, Bullous pemphigoid, SARS-CoV-2Word count: 451 wordsFigure count: 2Table count: 0Sijie Zhou1, Xue Wang1, Lizhi Ma1, Jiaming Fan1, Xinyun Tang1, Peimei Zhou1*1 Department of Dermatovenereology, Chengdu Second People’s Hospital, Qingyun Street, Chengdu, 610041, China.Correspondence to: Peimei Zhou, M.D., Ph.D.Department of Dermatovenereology, Chengdu Second People’s Hospital, Qingyun Street, Chengdu, 610041, China.Tel: +86 18908176315; E-mail: 46551704@qq.comFunding sources: NoneConflict of interest disclosures: All authors declare no conflicts of interest.Data availability statement: Data sharing does not apply to this article as no new data were created or analysed in this study.Ethics statement: The patient consented to publish this information. A 78-year-old male patient with a history of diabetes, hypertension, and renal insufficiency was diagnosed with bullous pemphigoid (BP) after contracting coronavirus disease 2019 (COVID-19). The patient had a positive nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in late December 2022 and was hospitalised for two to three weeks. After discharge, the patient developed erythema and blisters on both hands with itching that gradually involved the whole body. The patient presented to our dermatology department on 3 March 2023.At presentation to the dermatology department, the patient had tense blisters covering the entire body, some of which were breaking down, leaving a small patchy vesicular surface with a yellowish exudate (Fig. 1). Routine blood, procalcitonin, and C-reactive protein tests suggested infection, and a chest computed tomography exam indicated viral pneumonia, consistent with SARS-CoV-2 infection. In addition, the patient’s BP180 antibody levels were >150 U/mL (range: positive >20 U/mL), and rickle cell desmosome antibodies were negative. Furthermore, direct immunofluorescence showed linear basal deposition of immunoglobin G and C3 (uncertain). Finally, histological analyses of an incisional cutaneous biopsy obtained from the patient’s left lower extremity showed the formation of subepidermal blisters containing a few eosinophils, lymphocytes and fibrin, and some epidermal basal cells next to the blisters were edematous, liquefied and deformed.(Fig. 2). These findings were consistent with a BP diagnosis. The patient’s condition did not resolve after conventional treatment with glycyrrhizin, a Chinese herbal extract compound, and other anti-inflammatory treatments; therefore, dupilumab (600 mg initially, then 300 mg every two weeks after) was subcutaneously administered. The symptoms were relieved after two weeks.An increasing number of studies are reporting cutaneous manifestations after COVID-19. For instance, nonspecific skin symptoms, including urticarial lesions, chilblain-like lesions, vesicular eruptions, maculopapular rashes, and livedo, have been reported1,2. We identified no other reports of COVID-19-induced BP but did find a description of BP after SARS-CoV-2 vaccination3. The vaccine mimics antigens to induce specific immune responses in the body, similar to those produced by humans infected with novel coronaviruses, which can cause autoimmune symptoms4. Therefore, our case was likely associated with a novel coronavirus infection.BP is an autoimmune, subepidermal blistering disease occurring in elderly individuals. The exact pathogenesis of BP is unknown, but several factors, such as drugs, thermal or electrical burns, surgical procedures, trauma, ultraviolet irradiation, radiotherapy, chemical preparations, transplants, and infections, may induce or exacerbate BP5. Yet, viral infection-induced BP has rarely been considered. This may be because viruses, as pathogens, can induce cross-reactive autoantibodies sharing epitopes with host cells. Additionally, the virus can directly infect keratinocytes, induce the expression of hidden epitopes, modify existing epitopes, or insert envelope fragments into cells to produce new antigens, which could be responsible for BP development6,7.

SARS-CoV-2 and Crimean-Congo hemorrhagic fever virus coinfection: A case report and review of the diagnostic challengesZeinab Mohseni Afshar1, Mohammad Barary2, Arefeh Babazadeh3, Soheil Ebrahimpour3, *Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, IranStudent Research Committee, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, IranInfectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, IranCorrespondence: Soheil Ebrahimpour, Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran. Email: drsoheil1503@yahoo.com

With the emergence of new virus variants, there is limited data available on the impact of SARS-CoV-2 Omicron infection on surgery outcomes in cancer patients who have been widely vaccinated. This study aimed to determine whether undergoing hepatectomy poses a higher risk of postoperative complications for liver cancer patients who have had mild Omicron infection before surgery. A propensity-matched cohort study was conducted at a tertiary liver center from October 8, 2022, to January 13, 2023. Totally, 238 liver cancer patients who underwent hepatectomy were included, with 57 (23.9%) recovering from preoperative SARS-CoV-2 Omicron infection and 190 (79.8%) receiving COVID-19 vaccination. The average time from infection to surgery was 18.7 (range 7-49) days. The overall 30-day postoperative mortality rate was 1.7% (4/238). Pre- and post-matching, there was no significant difference in the occurrence of postoperative outcomes between preoperative COVID-19 recovered patients and COVID-19 negative patients. Multivariate logistic regression showed that the COVID-19 status was not associated with postoperative major pulmonary and cardiac complications. However, preexisting comorbidities (odds ratio [OR], 4.645; 95% confidence interval [CI], 1.295-16.667), laparotomy (OR, 10.572; 95% CI, 1.220-91.585), and COVID-19 unvaccinated (OR, 5.408; 95% CI, 1.489-19.633) had increased odds of major complications related to SARS-CoV-2 infection. In conclusion, liver cancer patients who have recovered from preoperative COVID-19 do not face an increased risk of postoperative complications. Therefore, elective cancer surgery can be safely performed after recovery for patients with a history of mild SARS-CoV-2 Omicron infection.

Introductionsince march 11, 2020 world health organization (WHO) reported a worldwide pandemic occurring by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) (1, 2). COVID-19 infections symptoms includes a variation of fever, cough, dyspnea, headache, myalgia and abdominal pain (3).Since then, there were reports of coinfections or misdiagnoses of covid-19 with other infections which have the same clinical or paraclinical symptoms (4, 5). Leptospirosis is a common infection in Southeast Asia and is one of those infections which can have the same symptoms as COVID-19 including cough and myalgia (6). In this study we are reporting a case that was not surely a severe pulmonary leptospirosis or covid-19.