Evaluate clinical effectiveness of Azvudine with data rather than speculationDaishi Li, MD1,2,3*, Yihuang Liu, MD1,2,3*, Minxue Shen, MD1,2,3,4#, Guangtong Deng, MD1,2,3#1 Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China2 National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China3 Furong Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan, China.4 Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, ChinaDaishi Li and Yihuang Liu contributed equally to this study.#Correspondence to Guangtong Deng, Minxue Shen, MD, Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China. E-mail: [email protected]; [email protected] the Editor,We appreciate the interest in our article entitled “Real-world effectiveness of Azvudine versus nirmatrelvir-ritonavir in hospitalized patients with COVID-19: A retrospective cohort study”.In their study, Ma et al. stated that antiviral therapies must be administered within five days of symptom onset to be effective. However, our study population included approximately 90% of patients beyond this treatment window. Moreover, we were unable to provide virological results, leading to Ma et al.’s speculation that treatment was unlikely to benefit patients in our study. They further praised the benefits of nirmatrelvir-ritonavir in COVID-19 patients and demonstrated their results supporting a faster time to nucleic acid negative conversion compared to patients receiving Azvudine. In a phase III trial, patients treated with Azvudine only showed a 50% reduction in viral load on the fifth day of treatment, making it difficult to achieve significant clinical efficacy. Ma et al. also concluded that the dose of Azvudine was insufficient for its antiviral effects, using data from drug experimental and pharmacokinetic studies. Finally, they called for the time to make more effective drugs available to COVID-19 patients.1As a retrospective study, we sought to collect more information, particularly on cycle thresholds in COVID-19 patients. However, as we previously reported, the cycle threshold value was no longer used as a discharge criterion during the period and was not regularly checked.2 Moreover, most electronic health records of COVID-19 patients only recorded quantitative results (positive or negative) upon admission, hence virological data was lacking. Nevertheless, it was not necessary for our study, which aimed to evaluate the real-world clinical effectiveness (composite outcomes and mortality). 3Azvudine and nirmatrelvir-ritonavir were recommended for the treatment of COVID-19 patients as early as possible, but these drugs were not strictly used according to the instructions during the special period. We acknowledged several limitations in our retrospective study, including the possibility of selection bias and confounding by indication. We also emphasized that our conclusions were solely based on data from our hospital and that the generalization of our findings required more high-quality and multi-center clinical trials.3 As clinicians, with limited knowledge about drug experimental and pharmacokinetics studies, we refrain from making any response on the topic of its antiviral effect. If there are any questions concerning the antiviral effect, we suggest contacting the corresponding authors of these studies.4,5 We can, however, discuss the clinical effectiveness of the drugs.We agree that numerous studies from other countries support the benefits of nirmatrelvir-ritonavir in treating COVID-19 patients.6 However, a multi-center randomized controlled study based on Chinese patients failed to detect a significant reduction in the risk of all-cause mortality on day 28 and the duration of virus clearance in severe adult COVID-19 patients.7 As our study mainly included severe COVID-19 patients in China, the limited efficacy of nirmatrelvir-ritonavir is not surprising.3,8 While Ma et al. found a faster time to nucleic acid negative conversion in patients receiving nirmatrelvir-ritonavir compared to those receiving Azvudine,1 it did not entirely negate our findings that support the better clinical benefit of Azvudine.3Evaluating a drug’s effectiveness requires clinical data, rather than piecing together several basic articles to make a speculation solely based on its antiviral effect. For instance, remdesivir can effectively inhibit COVID-19 infection in vitro but has no significant effect on COVID-19 patients who are already being ventilated.9Similarly, metformin, the most commonly used oral type 2 diabetic drug, functions in many diseases, including avoiding long COVID.10 Nowadays, compared with other anti-COVID-19 drugs, there is limited clinical study on Azvudine. Therefore, we call for more real-world studies to evaluate the effectiveness of Azvudine in COVID-19 patients.Finally, we appreciate the feedback from some readers regarding the flowchart of patient screening in Figure 1. To avoid any confusion, we would like to clarify that patients were repeatedly counted if they met individual exclusion criteria in the study. Additionally, pregnant patients were mistakenly classified to patients with history diseases. After matching, none of pregnant patients were included in Azudine and nirmatrelvir-ritonavir group. Therefore, our conclusions were still consistent.Declaration of Competing Interest: None.Acknowledgement: This work was supported by the National Natural Science Foundation of China (Grant Nos. 82102803, 82272849 to G. D.), National Natural Science Foundation of Hunan Province (Grant Nos. 2021JJ40976 to G. D.) and Natural Science Fund for Outstanding Youths in Hunan Province (2023JJ20093 to G.D.).Role of the funding source: The funding sources had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. All the authors had full access to all the data in the study and agree to submit the manuscript for publication.

Background: The lung-brain-axis is an emerging biological pathway that is being investigated in relation to microbiome medicine. Increasing evidence suggest that pulmonary viral infections can lead to distinct pathological imprints in the brain, thereby the need to explore and understand this mechanism and find possible interventions.  Objective:  This study used RSV infection in mice as a model to establish the potential lung-brain axis phenomenon. We hypothesized that RSV infection could disrupt the lung microbiota, thereby compromising the immune barriers and thus induces significant shift in microglia phenotype.  Methods: Mice were randomized into the Control, Ampicillin, RSV, and RSV+Ampicillin treated groups (n = 6 each). Ampicillin was given intratracheal instillation and seven days after the respective treatments, the mice were anesthetized. Hematoxylin-eosin (HE) staining of lung tissue to detect histopathology. Immunofluorescence label of specific target antigens in both the lung and brain tissues, namely, Malondialdehyde (MDA) and Superoxide dismutase (SOD) were used as markers of cellular damage. RT-qPCR was used to detect viral RNA in both tissues,  ELISA to measure IL-1β, iNOS, IL-10 and Arg1 in the supernatant and 16s DNA technology were used to detect the lung microflora.  Results: We found out that RSV infection induces elevated oxidative stress, reduced anti-oxidant and caused significant dysbacteriosis in the lungs of the mice. Pulmonary microbes were found affecting Th1-type immunoreactivity induced by RSV infection and eventually, microbiota in lung induced microglia phenotype shift in the brain of the mice.  Conclusion. This study was able to establish that RSV infection can disrupt the pulmonary microbiome and immune barriers to induce microglia phenotype shift. Thus, we recommend a large sample size study with robust data analysis for the long-term effects of antibiotics and RSV infection on brain physiology.

Monkeypox infections in the US and across the world have been rising in the past few months. Most of these infections have been found to be transmitted among men who have sex with men (MSM). Our case report discusses the rare presentation of a patient with monkeypox along with multiple comorbidities, including AIDS, late latent syphilis, acute hepatitis C, and asymptomatic and scrotal and penile cellulitis secondary to MRSA. Further, our case report raises discussion on the need for further research to identify the effect of monkeypox vaccine on symptomatic patients who are immunocompromised.

Objectives In a COVID-19 sero-surveillance cohort study with predominantly healthy and vaccinated individuals, the objectives were (i) to investigate longitudinally the factors associated with the quantitative dynamics of anti-spike IgG antibody levels, (ii) to evaluate whether the antibody levels were associated with protection from SARS-CoV-2 infection and (iii) to assess whether the association was different in the pre-Omicron compared with the Omicron period. Methods The QuantiVac Euroimmun ELISA test was used to quantify anti-S1 IgG levels. The entire study period (16 months), the 11-month pre-Omicron period and the cross-sectional analysis prior to the Omicron surge included 3219, 2310 and 895 reactive serum samples from 949, 919 and 895 study participants, respectively. Mixed-effect linear, mixed-effect time-to-event and logistic regression models were used to achieve the objectives. Results Age and time since infection or vaccination were the only factors associated with a decline of anti-S1 IgG levels. Antibody levels were significantly associated with protection from SARS-CoV-2 infection, and the association was higher for the Omicron than for the Alpha and Delta variants. In a prediction model, it was estimated that >8000 BAU/mL anti-S1 IgG was required to reduce the risk of infection with Omicron variants by 20% to 30% for 90 days. Conclusions Anti-S1 IgG antibody levels are associated with protection from infection. The levels in the pre-Omicron periods were less significant than during the Omicron surge, which in turn required very high levels for protection in a statistical model.

Severe fever with thrombocytopaenia syndrome virus (SFTSV) and Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause the hyperproduction of inflammatory cytokines, which have pathological effects in patient including severe or fatal cytokine storms. To characterize the effect of SFTSV and SARS-CoV-2 infection on the production of cytokines in SFTS and COVID-19 patients, we performed an analysis of cytokines in SFTS and COVID-19 patients and also investigated the role of IL-10 in vitro studies: LPS-induced THP-1-derived macrophages, SFTSV infection of THP-1 cells, and SARS-CoV-2 infection of THP-1 cells. In this study, we found that levels of both IL-10 and IL-6 were significantly elevated, the level of TGF-β was significantly decreased and IL-10 was elevated earlier than IL-6 in severe and critical COVID-19 and fatal SFTS patients, and inhibition of IL-10 signalling decreased the production of IL-6 and elevated that of TGF-β. Therefore, the hyperproduction of IL-10 and IL-6 and the low production of TGF-β have been linked to cytokine storm-induced mortality in fatal SFTS and severe and critically ill COVID-19 patients and that IL-10 can play an important role in the host immune response to severe and critical SARS-CoV-2 and fatal SFTSV infection.

Introduction: In this paper we examine the relationship between vaccination against COVID-19 and both the death rate from COVID-19 and the rate of COVID-19 spread. Our goal is determine if vaccination is associated with reduced death and/or spread of disease at the local level. Methods: This analysis was conducted at the county level in the state of Pennsylvania, United States of America, with data that were collected during the first half of 2022 from the state of Pennsylvania’s Covid Dashboard ([COVID-19 Data for Pennsylvania (pa.gov)](https://www.health.pa.gov/topics/disease/coronavirus/pages/cases.aspx) . Result s: Given that, during this time period, the vaccines being used were not geared specifically toward the common variants at that time, we found no statistically significant relationship between disease spread and vaccination rate at the county level. That said, we did find a highly statistically significant relationship between death rate and vaccination rate (p-value = 0.006). Specifically, a 1% increase in vaccination rate was found to correspond to a 0.751% decrease in death rate (95% confidence interval (0.236%, 1.266%)). Conclusions: These results support previous findings from across the world that Covid vaccination is highly efficacious in preventing death from the disease. Even during a time when vaccine design was not optimally matched with the prevailing strains, vaccination was found to reduce death rate. Hence, improving global vaccine availability is vitally important, in order to achieve necessary outcomes.

New-onset pemphigus after COVID-19Yihang Xie1 Mei Yang1 Peimei Zhou1* Jiaming Fan1 Sijie Zhou11.Department of Dermatovenereology, Chengdu Second People’s Hospital, Chengdu, China* Corresponding Author: [email protected] head: pemphigus after COVID‐19The category of the article: LetterKeywords: COVID‐19, pemphigusManuscript word count: 690 wordsThe number of figures: 2The number of tables: 0The number of references: 8Correspondence 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:[email protected] conflict of interest statement: Y. Xie, and my co-authors have no conflict of interest to declare.Ethics statement: The patient has consented to publish this information.Data availability statement: Data sharing does not apply to this article as no new data were created or analyzed in this study.Funding sources: noneDear Editor,Cutaneous manifestations of coronavirus disease (COVID-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; family Coronaviridae, genus Betacoronavirus, subgenusSarbecovirus ), have been increasingly reported. SARS-CoV-2 infection is multisystemic and leads to potentially detrimental effects on various organs. Maculopapular, urticarial, vesicular, livedoid, and Chilblain-like lesions (CBLL) have been commonly reported to be associated with COVID-191. Here, we encountered an intriguing case of pemphigus that developed after COVID-19 infection.A 73-year-old male presented with a 42-day history of pruritic flaccid blisters that arose on the trunk and both upper limbs on normal and erythematous skin. Cutaneous lesions started 3 days after the positive reverse transcription polymerase chain reaction (RT-PCR) test diagnostic for SARS-CoV-2. He denied any history of systemic diseases, medication, and medicine or food allergies, and had not used any medication before symptom onset. The patient had first been diagnosed with allergic dermatitis caused by COVID-19 at another hospital and was prescribed oral prednisone (8 mg once daily for 4 days). The patient reported no new blisters, but the erythema did not fade; therefore, he visited our hospital. Physical examination revealed cutaneous lesions on the trunk and both upper limbs without mucosal involvement and scattered superficial blisters that developed into crusted erosions on an erythematous base(Figure1 A-D). Laboratory examination revealed normal white cell count (8.63 Ö109/L; normal 3.5-9.5 Ö109/L) with eosinophilia (6%; normal 0.5%-5.0%). Desmoglein (Dsg) 1 antibody levels were > 150 U/mL (positive: > 20), while Dsg3, BP(bullous pemphigoid)180, and BP230 antibody levels were within normal ranges. Other laboratory tests including RT-PCR targeting SARS-CoV-2, immunoglobulin, erythrocyte sedimentation rate, the spectrum of antinuclear antibodies, and T-spot were negative or normal. Chest and abdominal computed tomography revealed chronic inflammatory changes but no obvious tumors. Histological analysis of an incisional cutaneous biopsy taken from the patient’s abdomen showed subcorneal blister formation, acantholytic cells within the blister, and marked spongiotic edema in the spongiosa layer that had mixed inflammatory infiltrate with eosinophils, leukomonocytes, and neutrophils(Figure2A). Direct immunofluorescence (DIF) showed deposition of intracellular IgG and C3 in subepidermal 2/3 interspinous cells, though was negative for IgA and IgM, confirming pemphigus(Figure2B,C). Considering the good response to hormone treatment, the patient continued oral prednisone at 8 mg once daily along with the use of topical corticosteroids. Symptoms were completely absent after 3 weeks(Figure1 E-F).An increasing number of studies on cutaneous manifestations of COVID-19 have been reported; however, knowledge is still lacking on the common skin manifestations of this disease. Nonspecific cutaneous manifestations due to SARS-CoV-2 infection have also been reported, such as immune thrombocytopenic purpura (ITP), dengue-like exanthem, pityriasis rosea-like eruptions, acral ischemia, mucositis, dusky lesions, and bullae2.3.4. We searched all relevant articles and found only two cases of pemphigus vulgaris induced by COVID-19. In the case presented here, we realized that COVID-19 may be responsible for the rash eruption, possibly due to an inflammatory reaction5. The onset time of the rash was similar to that in the cases of pemphigus previously reported by De Medeiros5 and Mohaghegh F6 (within 1.5 months). In our case, although direct immunofluorescence showed subepidermal 2/3 deposition, we still diagnosed pemphigus foliaceus in combination with the pathological presentation, indirect immunofluorescence, and good treatment outcome. We speculate that the reason why direct immunofluorescence showed subepidermal 2/3 deposition may be the marked sponge edema of the epidermis, which may lead to a discontinuity of acantholysis, resulting in leakage of Dsg1 into the deeper epidermis.Pemphigus is defined as a group of rare mucocutaneous autoimmune diseases. Its etiology is unknown, though there are studies on autoimmune etiology which is believed to be related to stimulation by certain drugs, ultraviolet radiation, and malignant tumors; these induce autoimmune reactions by making the adhesive substances between the spiny cell layers become autoantigens7. It is rarely considered, however, that viral infections might cause pemphigus. The ability of SARS-CoV-2 to induce a hyper-stimulated immune state was discovered at the beginning of the pandemic8. As an instrumental trigger of autoimmunity, SARS-CoV-2 infection could be a trigger for autoimmune reactions, possibly through more than one mechanism. Because of this, all factors should be considered in any patient presenting with new-onset or exacerbating cutaneous reactions.

Since 1999, Vaccinia virus (VACV) has been described as a causative agent of bovine vaccinia (BV), a zoonotic disease that occurs mainly in rural areas of Brazil. However, the circulation of VACV in urban environments and its associated burden has been poorly explored. Moreover, the current Mpox outbreak has raised questions regarding the immune status of the worldwide population previous vaccinated against smallpox. Hence, we conducted a cross-sectional study to better understand the prevalence of anti-OPV neutralizing antibodies (NA) in a susceptible urban population of Brazil. A total of 372 individuals were sampled, yielding an overall seroprevalence of 16.9% (CI95%=13.4–21.1), and antibodies titers ranging from 100 to 800 NU/ml. The prevalence of NA among vaccinated individuals (≥36yo) was 24.9% (IC 95%=19.5–31.2), and among those unvaccinated (<36yo) was 6.7% (IC 95%=3.7–11.8). Multivariate logistic regression analysis indicated that age ≥36yo and the presence of vaccine take were independently associated with the presence of anti-OPV NA. Our findings suggest that vulnerable populations could be subclinically exposed to VACV in urban areas, drawing attention to alternative routes of zoonotic VACV exposure. Our data is also important for better strategies in order to mitigate zoonotic OPV infections mainly among vulnerable populations.

In May 2022, several countries reported mpox cases from patients without history of traveling to endemic areas. France was one of the most affected European countries. In this study, we described the clinical characteristics of mpox cases in France, and studied the genetic diversity of the virus. Patients diagnosed with mpox infection (qPCR ct<28) between 21 th May and 4 th July 2022 and between 16 th August and 10 th September 2022 were included to this study. Twelve amplicons corresponding to the most polymorphic regions of the mpox genome and covering ~30,000 nucleotides were generated and sequenced using the S5 XL Ion Torrent technology to evaluate the genetic diversity of mpox sequences. One hundred and fourty-eight patients were diagnosed with mpox-infection. 95% were men, 5% transgender (M-to-F), 50% were taking HIV pre-exposure prophylaxis, and 25% were HIV seropositive. One hundred and sixty-two samples were sequenced and compared to GenBank sequences. Thirty-two distinct mutational patterns were identified. Overall, low genetic diversity of mpox sequences was found compared with pre-epidemic Western-African sequences, with 32 distinct mutational patterns. Our results provide a first glance at the mutational landscape of early mpox 2022 circulating strains in Paris (France).

Sexually transmitted infections (STIs) are a major global public health concern, with human papillomavirus (HPV) being one of the most common STIs affecting both men and women worldwide [1]. It is estimated that about 75% of sexually active people will contract HPV at some point in their lives [1]. The impact of HPV on health can be severe, causing various health problems such as genital warts, cervical, anal, penile, and oropharyngeal cancers [2].Several studies conducted in Africa have shown significant HPV prevalence rates among men who have sex with men (MSM). In sub-Saharan Africa, HPV was detected in a range of 19.1% to 100% of men, with a pooled prevalence of 78.2% among HIV-positive men and 49.4% among HIV-negative men [3]. Another study in South Africa found that HPV genotypes were detected in 72.8% of anal, 11.5% of oro-pharyngeal, and 15.3% of urine specimens of MSM, with multiple HPV types being more common in the anal canal [4]. Additionally, a study in Nigeria reported a higher prevalence of anal high-risk HPV (HR-HPV) among HIV-positive MSM compared to HIV-negative MSM [5], while another study in Mali found that a significant percentage of MSM had anal HPV infection of any genotypes, with a large portion being HR-HPV positive [6]. The increasing prevalence of anal HR-HPV among MSM in Africa highlights the urgent need for increased HPV screening and prevention measures targeted at this population, particularly HIV-positive MSM.HPV vaccination programs are highly effective in reducing the burden of HPV and associated diseases in both men and women [3]. The vaccine offers long-lasting protection against HPV infections that are most commonly associated with cancer [7]. Although the vaccine is primarily known for preventing cervical cancer in women, it can also prevent HPV-related cancers in men, such as anal, penile, and oropharyngeal cancers [7]. Moreover, vaccinating men can lead to herd immunity, which can protect women from HPV-related diseases [2]. Therefore, it is essential to prioritize the HPV vaccine for MSM who engage in anal sex to prevent HPV-related cancers and reduce the overall burden of HPV in Africa.However, the low uptake of the HPV vaccine in Africa, especially among high-risk individuals, is concerning despite the vaccine’s effectiveness in preventing HPV-related diseases. Only 14 of the 54 African nations have included the HPV vaccine in their national immunization programs for girls as of 2021, and no countries in western and central Africa have included widespread HPV vaccination in their national immunization programs [8 10]. Furthermore, currently, no countries in Africa offer HPV vaccination to men [8]. This means that individuals engaging in anal sex, who are at a higher risk of developing anal cancer, are not receiving the protection they need, despite the high prevalence of HPV infection among MSM. This underscores the urgent need to prioritize the inclusion of the HPV vaccine in national immunization programs in Africa, and to ensure equitable access to the vaccine for all persons, including MSM.To improve access to healthcare services and HPV vaccination for MSM in Africa, it is crucial to address both the structural and social barriers that hinder their access to these services. Some of the barriers that HPV-infected MSM face include a lack of information, general vaccine hesitancy, a lack of advice from healthcare professionals, expense and logistics, and the perception that HPV vaccination may encourage promiscuity [9]. Furthermore, discrimination and the criminalization of same-sex behavior can further prevent MSM from accessing healthcare programs [10].A comprehensive approach is necessary to overcome these barriers and improve access to healthcare services and HPV vaccination for MSM in Africa. This includes community-based interventions [11], and healthcare professional training to increase awareness about HPV, the benefits of vaccination, and to reduce vaccine hesitancy among MSM [12]. Healthcare professionals should also receive training to provide culturally competent care to meet the unique healthcare needs of MSM in a non-judgmental manner [12]. Policy changes are also necessary to eliminate discrimination and criminalization of same-sex behavior and enable MSM to access healthcare services without fear of stigma or persecution [10]. Moreover, to increase vaccine coverage in Africa, the HPV vaccine should be made affordable and accessible to all individuals, regardless of their socioeconomic status [10]. This can be achieved by implementing community-based vaccination programs, mobile clinics, and school-based vaccination programs. Overall, these interventions can help to improve vaccination rates and increase access to healthcare services for MSM in Africa, ultimately leading to better health outcomes and reducing health disparities.

As the Coronavirus Disease 2019 (COVID-19) outbreak spread, evidence has emerged that gender and race would bear a disproportionate impact on the morbimortality of COVID-19. Here, we conducted a retrospective observational study using the TabNet/DATASUS platform of the city of São Paulo. COVID-19 records from March 2020 thru December 2021 were included, and we evaluated the temporal trends of confirmed cases and case fatality rate by gender and ethnicity. Statistical analysis was performed using the R-software and the BioEstat-software, considering p<0.05 significant. From March/2020 to December/2021, 1,315,160 COVID-19 confirmed cases were recorded (57.1% females), and 2,973 deaths were due to COVID-19. Males presented higher median mortality (0.44% vs 0.23%; p<0.05) and ICU admission rates (0.34% vs 0.20%; p<0.05). Men were also associated with a higher risk of death (RR=1.28; p<0.05) and a higher chance of requiring ICU care (RR=1.29; p<0.05). The black ethnicity was associated with a higher risk of death (RR=1.19; p<0.05). White patients were more likely to require ICU admission (RR=1.13; p<0.05), whereas browns were associated with a protective effect (RR=0.86; p<0.05). Further, men presented a higher chance of death than women across the three major ethnic groups: whites (RR=1.33; p<0.05), blacks (RR=1.24; p<0.05), and browns (RR=1.35; p<0.05). In this study of COVID-19 in São Paulo, men were associated with worse outcomes, including in the three major ethnicities in the population. Blacks exhibited a higher risk of death, whites were more likely to require intensive care, and browns were at protection from ICU hospitalization.

Early in the 2022 Mpox (MPX) global outbreak, caseloads in the New York Metropolitan area climbed rapidly before other US urban areas. This case series summarizes the authors’ clinical experience detecting and treating MPX, during a quickly evolving outbreak. Clinical outcomes were recorded with a focus on varied clinical presentation and outcomes such as complications and response to experimental tecovirimat therapy. A focal or multifocal rash was the most common presenting symptom in 91% of patients. Almost two thirds (62%) of patients had anogenital involvement. Proctitis was one of the most painful presentations with 75% requiring antiviral treatment and 3 patients needing hospitalization for pain management. Most patients responded promptly to antiviral treatment with tecovirimat. Five out of 10 patients treated with tecovirimat reported symptom resolution within 48 – 72 hours of therapy and another 3 saw resolution within first 96 hours. Two patients had poor response to tecovirimat. This series includes the only reported case of an HIV positive, immunocompetent patient who experienced recurrent anal ulcers due to Mpox and required a second course of tecovirimat. Other unique presentations included urethritis, abscess formation and MPX infection post-vaccination. Control of this current Mpox outbreak was possible due to timely diagnosis and the availability of both a licensed vaccine and an investigational drug.

Commentary:Herpes simplex virus and SLE: though uncommon yet with significant implicationsNaim Mahroum1, Abdulrahman Elsalti1, Yehuda Shoenfeld21International School of Medicine, Istanbul Medipol University, Istanbul, Turkey.2Zabludowicz Center for autoimmune diseases, Sheba Medical Center, Ramat-Gan, Israel.Running title : Commentary: Herpes simplex virus and SLE: though uncommon yet with significant implicationsKeywords – Autoimmunity, infection and autoimmunity, systemic lupus erythematosus, human herpes viruses, herpes simplex virus

SARS-CoV-2 causes COVID-19 pandemic and continues to pose a threat to global public health through genetic mutation. In this study, we have found that an ACE2-specific monoclonal antibody at low concentration was able to greatly enhance SARS-CoV-2 infection and growth in cell culture. Strikingly, it promotes SARS-CoV-2 plaque formation, resulting in accurate titration of different SARS-CoV-2 variants, particularly the newly emerged Omicron variants, which otherwise cannot be determined by standard plaque assays. Quantification of infectious titers of the newly emerged variants will facilitate the development and evaluation of vaccines and antiviral drugs against SARS-CoV-2.

Background: Killer-cell immunoglobulin-like receptors 2DL4 ( KIR2DL4) and the human leukocyte antigen class I-G ( HLA-G) display vital parts in immune responses against HCV infection. We select four potentially functional SNPs of KIR/HLA to explore the associations between KIR2DL4/HLA-G genetic variants and HCV infection results. Methods: In the present case-control investigation, KIR2DL4-rs660773， KIR2DL4-rs660437， HLA-G-rs9380142, and HLA-G-rs1707 SNPs were sorted as genotype in a total of 2225 high-risk subjects, involving 1778 paid blood donors and 447 drug users. The SNPs were functionally annotated using bioinformatics analysis. Results: Following adjusting by age, sex, ALT, AST, IFNL4-rs12979860, IFNL4-rs8099917, and the infection route, the logistic regression analysis (LRA) discovered that KIR2DL4-rs660773 and HLA-G-rs9380142 were correlated with vulnerability to HCV infection (all P <0.05). In a locus-dosage way, compared with subjects carrying the rs9380142-AA or rs660773-AA genotypes, subjects with rs9380142-AG or rs660773-AG/GG (all P <0.05) were more vulnerable to HCV infection; the overall impact of their risk genotypes (rs9380142-AGrs660773-AG/GG) was correlated with an elevated incidence of HCV infection ( Ptrend<0.001). In the Haplotype analysis, patients with haplotype AG were more likely to contract HCV compared to those with the highest common AA haplotype ( P= 0.002) were higher in susceptibility to infect HCV.nThe SNPinfo web server estimated that rs660773 is a transcription factor binding site (TFBS), whereas rs9380142 is a potential microRNA-binding site. Conclusion: In the Chinese high-risk population, KIR2DL4 rs660773 and HLA-G rs9380142 polymorphisms are related to HCV susceptibility .

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can lead to diverse clinical manifestations and pathologies that involve multiple organs. Even though the disease severity is manifested mainly in the respiratory tract, which is the primary target of SARS-CoV-2 infection, acute kidney injury in the form of acute tubular necrosis has also been noted in some COVID-19 cases. It is not entirely clear whether renal cells can be infected by the virus that might be involved in acute kidney disorder. In a recent publication by Radovic and colleagues (1) that has been selected as the editor’s choice paper published in the Journal of Medical Virology, the authors provided strong histopathological and immunofluorescence evidence of SARS-CoV-2 infection and tissue injury of renal parenchymal and tubular epithelial cells, which strongly suggest an active viral replication in the kidney of some severe and fatal COVID-19 cases, and to a lesser extent, a potential role for innate immune cells in viral infection and renal disease pathogenesis.

1. A survey on the recent COVID-19 epidemic in China was conducted. 2. The epidemic likely made over 85% of people in China sick in December 2022. 3. The epidemic likely ended in early January 2023. 4. The epidemic had the features of spreading more rapidly and widely and having a higher symptomatic rate than previously thought. 5. The above features could lead to many severe cases and deaths due to the shortages of medical resources. 6. The above features greatly enhanced the population immunity in China, which will accelerate the end of the COVID-19 pandemic and reduce the emergence of risky variants of SARS-CoV-2 in China.

A group of viruses, collectively known as Pteropine orthoreoviruses (PRVs), have recently been found in fruit bats and humans in Southeast Asia, Australia, and some African countries. This article intends to briefly discuss what is known about these viruses and their potential significance in public health and to advocate for increased surveillance of these zoonotic viruses to prevent potential future disease outbreaks, as well as to highlight a recent publication on this topic that was selected as an editor’s choice article in the Journal of Medical Virology 1.