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SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients

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... The use of heat to inactivate virus has been reported to reduce viral RNA stability Zou et al., 2020); and depending on the target gene used for RT-PCR, incubation at 65°C for 30 min can significantly reduce the target copy numbers, leading to falsenegative results of clinical samples Zou et al., 2020). The DCL has an accredited SARS-CoV-2 diagnostic workflow (UKAS, 2020) using the Qiagen and KingFisher (using MagMAX Protocol 1) extraction platforms each with an additional heat inactivation step. ...
... The use of heat to inactivate virus has been reported to reduce viral RNA stability Zou et al., 2020); and depending on the target gene used for RT-PCR, incubation at 65°C for 30 min can significantly reduce the target copy numbers, leading to falsenegative results of clinical samples Zou et al., 2020). The DCL has an accredited SARS-CoV-2 diagnostic workflow (UKAS, 2020) using the Qiagen and KingFisher (using MagMAX Protocol 1) extraction platforms each with an additional heat inactivation step. ...
... The range of specimens already used for performing the diagnosis of the virus by NAAT is diverse. It includes samples collected from upper respiratory tract (URT) , such as nasal (NS) (Calame et al., 2020;Zou et al., 2020), midturbinate (M-T) (Barat et al., 2021), nasopharyngeal (NP) , throat (TH) and oropharyngeal (OP) (Peng L. et al., 2020) regions, as well as saliva ; while others are retrieved from lower respiratory tract (LRT) , such as sputum , endotracheal fluid (EDF) (Bergrath et al., 2020), or the liquid resulting from a brochoalveolar lavage (BAL) . The major international health institutions, like CDC and ECDC recommend the use of URT specimens like NP or OP swabs as a first choice, particularly in asymptomatic, mild or moderate disease cases (CDC, 2020a;ECDC, 2020a). ...
... As with the detection of infectious virus, several other parameters can influence whether viral load can be detected. The site of specimen collection can impact the findings on viral load; although some studies report higher RNA viral load in nasal or nasopharyngeal swabs 28,29 , others show higher RNA viral load in throat samples 30 . Moreover, the transport ...
... The anatomical site chosen to collect the swab specimen for detection of SARS-CoV-2 might influence viral load detection. Higher RNA viral load was reported from nasopharyngeal than oropharyngeal swabs 28,124,181 . As a result, nasopharyngeal samples show the highest diagnostic accuracy compared with other upper respiratory tract samples 182 . ...
... After the emergence of SARS-CoV-2 in late 2019, the first details on viral load and infectious virus shedding were measured in a cluster of infections that occurred in January 2020 in Germany, assessing nine immunocompetent individuals with a mild course of disease 4 . Peak RNA viral loads were reached in the early symptomatic period at 5 dpos, a finding that was confirmed by other studies reporting peak viral loads at the time of symptom onset or even shortly before 4,7,28,59 . RNA viral loads gradually declined over the course of the disease in the nasopharyngeal and throat swabs, reaching low or undetectable levels 2 weeks after symptom onset 4,23,59,60 (Fig. 2). ...
Article
SARS-CoV-2 viral load and detection of infectious virus in the respiratory tract are the two key parameters for estimating infectiousness. As shedding of infectious virus is required for onward transmission, understanding shedding characteristics is relevant for public health interventions. Viral shedding is influenced by biological characteristics of the virus, host factors and pre-existing immunity (previous infection or vaccination) of the infected individual. Although the process of human-to-human transmission is multifactorial, viral load substantially contributed to human-to-human transmission, with higher viral load posing a greater risk for onward transmission. Emerging SARS-CoV-2 variants of concern have further complicated the picture of virus shedding. As underlying immunity in the population through previous infection, vaccination or a combination of both has rapidly increased on a global scale after almost 3 years of the pandemic, viral shedding patterns have become more distinct from those of ancestral SARS-CoV-2. Understanding the factors and mechanisms that influence infectious virus shedding and the period during which individuals infected with SARS-CoV-2 are contagious is crucial to guide public health measures and limit transmission. Furthermore, diagnostic tools to demonstrate the presence of infectious virus from routine diagnostic specimens are needed. A better understanding of the transmission of SARS-CoV-2 is essential to inform public health measures. In this Review, Puhach, Meyer and Eckerle explore insights into what influences SARS-CoV-2 shedding, how this drives transmission and the tools available to measure this and determine infectiousness.
... This all comes with a small sensitivity tradeoff, for not potentially detecting weak positive samples with low virus counts. Thus, the GenomEra SARS-CoV-2 assay might not be suitable for screening non-symptomatic patients, as the potentially lower viral load in these cases might cause false negative results [24][25][26]. In acute SARS-CoV-2 infection, the virus amount is typically extremely high and thus the assay is not usually limited by the test sensitivity [23,24]. ...
... Thus, the GenomEra SARS-CoV-2 assay might not be suitable for screening non-symptomatic patients, as the potentially lower viral load in these cases might cause false negative results [24][25][26]. In acute SARS-CoV-2 infection, the virus amount is typically extremely high and thus the assay is not usually limited by the test sensitivity [23,24]. Also, the transmissibility of COVID-19 positive patients depends on the viral load, highlighting the importance of detecting the individuals with high potential of mediating SARS-CoV-2 infection [24][25][26]. ...
... In acute SARS-CoV-2 infection, the virus amount is typically extremely high and thus the assay is not usually limited by the test sensitivity [23,24]. Also, the transmissibility of COVID-19 positive patients depends on the viral load, highlighting the importance of detecting the individuals with high potential of mediating SARS-CoV-2 infection [24][25][26]. ...
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Article
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first emerged in late 2019, and quickly spread to every continent causing the global coronavirus disease 2019 (COVID-19) pandemic. Fast propagation of the disease presented numerous challenges to the health care industry in general and especially placed enormous pressure on laboratory testing. Throughout the pandemic, reverse transcription-PCR (RT-PCR)-based nucleic acid amplification tests have been the primary technique to identify acute infections caused by SARS-CoV-2. Since the start of the pandemic, there has been a constantly growing need for accurate and fast tests to enable timely protective and isolation means, as well as rapid therapeutic interventions. Here we present an evaluation of the GenomEra test for SARS-CoV-2. Analytical and clinical performance was evaluated in a multicenter setting with specimens analyzed using standard-of-care (SOC) techniques. Analytical sensitivity was assessed from spiked respiratory swab samples collected into different viral transport media, and in the best performer eSwab, the limit of detection was found to be 239 IU/mL in a heat processed sample. The GenomEra SARS-CoV-2 Assay Kit did not show specificity/cross-reactivity issues with common micro-organisms or other substances commonly found in respiratory specimens when analyzed both in vitro and in silico . Finally, the clinical performance was assessed in comparison to SOC techniques used at four institutions. Based on the analysis of 274 clinical specimens, the positive agreement of the GenomEra SARS-CoV-2 Assay Kit was 90.7%, and the negative agreement was 100%. The GenomEra SARS-CoV-2 Assay Kit provided accurate detection of SARS-CoV-2 with a short turnaround time in under 90 min.
... This is due to the similar viral loads detected from nasal and throat swabs from each patient population, with a slightly higher predominance of virus detected via nasal swab. 5,19 COVID-19 infectiousness is highest in the early course of the illness, during the 2 days before symptom onset. This viral nucleic acid shedding pattern of SARS-CoV-2 resembles that of influenza and can make it difficult to control transmission. ...
... This viral nucleic acid shedding pattern of SARS-CoV-2 resembles that of influenza and can make it difficult to control transmission. 19 Specific to immunocompetent individuals, an infected patient is less likely to transmit the virus after day 7. 12,20,21 Within an emergent setting, patients with COVID-19 infection can present with symptoms ranging in severity from mild to severe. Common complaints include fever, cough, dyspnea, myalgia, loss/alterations of gustatory and olfactory senses, gastrointestinal manifestations (most commonly diarrhea), and headaches. ...
Article
Pneumonia is a common diagnosis encountered by emergency medicine providers. It is crucial that an accurate and timely diagnosis is established in order to appropriately manage each patient. Following the outbreak of SARS-CoV-2 in 2019, the frequency of patient visits to the emergency department for symptoms consistent with pneumonia have increased and overwhelmed virtually all hospital systems. The rapid identification of COVID-19 patients is imperative for patient care and to these hospital systems experiencing the pandemic. Community-acquired bacterial pneumonia continues to be prevalent and clinical decision-making tools are useful aids to assist the appropriate disposition of patients.
... through the nose when a person coughs, sneezes, or talks. The highest viral loads were found in the nose and throat after symptom onset [29]. The clinical manifestations of COVID-19 include but are not limited to fever, cough, fatigue, muscle aches, and loss of taste and smell [1]. ...
... The clinical manifestations of COVID-19 include but are not limited to fever, cough, fatigue, muscle aches, and loss of taste and smell [1]. Even though not everyone who contracts the COVID-19 virus is symptomatic, those who are asymptomatic are found to have similar viral load contents to those of symptomatic patients [29]. According to the Centers for Disease Control and Prevention (CDC), although COVID-19 is relatively mild in most cases, the severe and fatal cases are seen among the elderly and those with underlying medical conditions, including cardiovascular disease, hypertension, and diabetes. ...
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Article
Coronavirus disease 2019 is caused by SARS-CoV-2 and is more severe in the elderly, racial minorities, and those with comorbidities such as hypertension and diabetes. These pathologies are often controlled with medications involving the renin–angiotensin–aldosterone system (RAAS). RAAS is an endocrine system involved in maintaining blood pressure and blood volume through components of the system. SARS-CoV-2 enters the cells through ACE2, a membrane-bound protein related to RAAS. Therefore, the use of RAAS inhibitors could worsen the severity of COVID-19’s symptoms, especially amongst those with pre-existing comorbidities. Although a vaccine is currently available to prevent and reduce the symptom severity of COVID-19, other options, such as nitric oxide and hydrogen sulfide, may also have utility to prevent and treat this virus.
... Of the 69 patients, 39 (56.5%) were male and 30 (43.5%) were female. The average age of the subjects was 32.8 (range, [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] years. Cough (66.7%) was the most common early symptom of COVID-19 (Table 1). ...
... SARS-CoV-2 infection can spread rapidly and cause severe morbidity and mortality. 28 The oral cavity and URT have high viral loads and are potential sources of SARS-CoV-2. 29 Kim et al. 30 found that viral shedding was high in the URT from the prodromal phase to day 5 after symptom onset. ...
Article
Background: Coronavirus disease 2019 can spread rapidly. Surgery in the oral cavity poses a high risk of transmission of severe acute respiratory syndrome coronavirus 2. The American Dental Association and the Centers for Disease Control and Prevention recommend the use of mouthwash containing 1.5% hydrogen peroxide (H 2 O 2 ) or 0.2% povidone iodine (PI) to reduce the viral load in the upper respiratory tract and decrease the risk of transmission. The aim of the present study was to analyze the effect of mouth rinsing and gargling with mouthwash containing 1% PI, 0.5% PI, 3% H 2 O 2 , or 1.5% H 2 O 2 and water on the cycle threshold (CT) value obtained by real-time reverse transcription polymerase chain reaction (RT-PCR). Methods: This study is a randomized single blind controlled clinical trial which has been registered in the International Standard Randomized Controlled Trial Number (ISRCTN) registry on the 3 rd February 2022 (Registration number: ISRCTN18356379). In total, 69 subjects recruited from Persahabatan General Hospital who met the inclusion criteria were randomly assigned to one of four treatment groups or the control group. The subjects were instructed to gargle with 15 mL of mouthwash for 30 s in the oral cavity followed by 30 s in the back of the throat, three times per day for 5 days. CT values were collected on postprocedural days 1, 3, and 5. Results: The results of the Friedman test significantly differed among the groups (n=15). The CT values increased from baseline (day 0) to postprocedural days 1, 3, and 5. Conclusions: Mouth rinsing and gargling with mouthwash containing 1% PI, 0.5% PI, 3% H 2 O 2 , or 1.5% H 2 O 2 and water increased the CT value.
... It was discovered early that the amount of virus RNA in patient samples could differ by more than a factor of a million. 25 Obviously, an infected person is more infectious than another infected person if he or she excretes one million times more virus. In fact, in the first wave of Covid-19 with the first variant (Wuhan) of SARS-CoV-2, it was estimated that only every fifth infected person transmitted the virus. ...
... Although, infection could also be occurring through the respiratory secretions. Through sneezing, coughing, and talking if a virus makes direct contact with the mucous membrane, a person will become affected (Zou L, Ruan F, Huang M, et al. 2020). ...
Article
The present study promotes study aim and unfolds the negative consequences of Corona Virus Infectious Disease in regard of social, economic and psychological lives of people in village Bamkhel District Swabi. Sample sizes of 234 respondents have been chosen for this data which includes shopkeepers, labors, government employees and religious priest. The data was collected through questionnaire and interview schedule from each and every individual, which contains different questions. Simple random sampling technique was used for the collection of relevant data. As corona virus impacted the whole world in every aspect of life. Objective of the study was to explore the social-psychological impacts of corona virus on the lives wellbeing of the people. It has been concluded from the findings that Corona virus has impacted the lives of people badly in all most every aspect of life, whether it is social, or psychological. The findings also depict that a lot of people became jobless which resulted in the increase of unemployment. The study concluded that due to closing of educational institutions the schooling of children has been effected negatively. The study recommends that by following the SOP’s which are directed by the government and health care centers the corona virus can be controlled and will not spread rapidly otherwise the situation will be harder in the future.
... Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a novel coronavirus with high potent of person-to-person transmission and thus contributing to a large outbreak of coronavirus disease 2019 (COVID-19) [1,2]. COVID-19 mainly causes fever and respiratory symptoms. ...
... Ct values were negatively correlated with viral RNA copy numbers. 12 According to the instructions of the RT-PCR kit, patients with Ct values less than 40 were considered positive. ...
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Chunjing Du,1,* Siyuan Yang,2,* Chuansheng Li,1 Pan Xiang,1 Lin Pu,1 Jingyuan Liu1 1Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Laboratory of Infectious Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jingyuan Liu; Lin Pu, Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshundong Street, Chaoyang District, Beijing, 100015, People’s Republic of China, Tel +86 108432682; +86 108432966, Email dtyyicu@ccmu.edu.cn; pulin1103@ccmu.edu.cnIntroduction: Information regarding the clinical course of COVID-19 patients with liver injury is very limited, especially in severe and critical patients. The objective of this study was to describe the characteristics and clinical course of liver function in patients admitted with severe and/or critical SARS-CoV-2 infection, as well as explore the risk factors that affect liver function in the enrolled COVID-19 patients.Methods: Information on clinical characteristics of 63 severe and critical patients with confirmed COVID-19 was collected. Data on patients’ demographics, laboratory characteristics, laboratory examination, SARS-CoV-2 RNA results and liver test parameters were acquired and analyzed.Results: The incidence of abnormal aspartate aminotransferase, alanine aminotransferase, and total bilirubin in the critical group was significantly higher than in the severe group (respectively 81.48%, 81.49%, 62.67%, and 45.71%, 63.88%, 22.86%, p < 0.05). The time for liver function parameters to reach their extremes was approximately 2– 3 weeks after admission. The independent factors associated with liver injury were patients with invasive ventilators, decreased percentages of neutrophils, lymphocytes and monocytes, and sequential organ failure assessment (SOFA) score ≥ 2 (p < 0.05).Conclusion: Abnormal liver tests are commonly observed in severe and critical patients with COVID-19. Severe patients infected by SARS-CoV-2 should be closely observed and monitored the liver function parameters, particularly when they present with independent risk factors for liver injury.Keywords: abnormal liver tests, coronavirus disease 2019, COVID-19, liver injury, pneumonia, severe acute respiratory syndrome coronavirus 2, SARS-CoV-2
... У міру заповнення альвеол рідиною, наростає дихальна недостатність. Смерть настає при порушенні цілісності альвеолярної мембрани, що веде до накопичення рідких ексудатів в альвеолярному просторі, механічна вентиляція легень може виявитися марною [30]. ГРДС -це форма ураження легенів, яка також характеризується запаленням, набряком легеневих судин і, як наслідок, втратою аерованої легеневої тканини. ...
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Having analyzed the latest recommendations of the World Health Organization, the new data from the scientific literature, and current treatment guidelines, the latest epidemiological data of identified different cases of this infection according to epidemiological and clinical criteria were presented. The main pathogenetic signs, risk factors, including inter-individual differences, which can be represented by the host's genetic profile, are highlighted. The main clinical signs and their distribution, classification according to the severity of the disease, features of the course and treatment of pneumonia in human coronavirus infections are shown, including indications for antibacterial therapy and the main criteria of oxygen support. The basic WHO laboratory recommendations for patients with acute respiratory infection who have been in contact with patients having a confirmed or probable case are defined. The main hardware methods of diagnosis, modern approaches in the therapy in the absence of specific antiviral agents are presented. The lack of definitive specific treatment for this disease and the future development of such a pandemic remains unpredictable that indicates the need for strict adherence to classic public health recommendations, the importance of vaccination. The outbreak of COVID-19 in this century once again had emphasized the constant threat of infectious diseases spread by pathogenic viruses among humanity and this requires effective global cooperation and a high level of preparedness.
... of the onset of symptoms, patients with COVID-19 infections have demonstrated high viral loads in their upper and lower respiratory tract. 35-38 A nasopharyngeal (NP) swab and/or an oropharyngeal (OP) swab are often recommended for screening or diagnosis early infection.36,39,40 Ideally, sputum or bronchoalveolar lavage should be used for collecting lower respiratory tract specimens as they yielded highest viral loads for the diagnosis of COVID-19.41,42 ...
... Therefore, nasopharynx swab samples carry higher viral loads, when compared to those detected in the oropharynx, during the q-RT-PCR test. 16 As defined in the literature, certain spray formulations have been investigated under two main categories: those that actively target the virus (e.g., products, such as SaNOtize), and those that passively protect the mucosa against viral contamination (e.g., Taffix and Vicks First Defense). The product named, SaNOtize, was developed in Canada. ...
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Abstract Background and Aims The real target planned is the prevention of COVID-19 using natural treatment tools, other than medical drugs, together with the use of vaccines. Similar to various viruses that lead to upper respiratory diseases, SARS-CoV-2 most frequently enters the body through the nasal cavity and oral cavity. It has been stated that the Oscardia Ledovir Spray can form a mechanical barrier in the mucosa of the nasal and oral cavities, which are the points of entry of the SARS-CoV-2 virus in the body, preventing the bonding of the virus to the receptors, and inhibiting any virus it encounters through direct contact. Methods The present study serves as evidence for this treatment. The application of disinfectants in percentage formulations has been officially accepted by the World Health Organization to kill viruses, and this was used to compare its effectiveness with the Oscardia Ledovir Spray. The obtained new sample mixture was placed in a plate. In the course of the study, it was determined that the Oscardia Ledovir Spray has an effect mechanism similar to ethyl alcohol and disinfectants. Results Since the Oscardia Ledovir Spray was found to have an effect mechanism similar to ethyl alcohol and disinfectants, this was considered as the preferred treatment approach. The results of the present clinical study revealed that this treatment approach is effective, particularly for SARS-CoV-2. Conclusions The Oscardia Ledovir Spray can be considered to provide both prophylactic and therapeutic benefits, thereby contributing to humanity in improving processes that range from simple infections to serious diseases. Furthermore, it was considered that this treatment can be used for both SARS-CoV-2, and viral and bacterial infections.
... It was demonstrated that IL-13-induced airway mucus obstruction was an important feature of type 2 high asthma, and that IL-13 generally reduced innate airway defenses, resulting in a pathological mucus secretome that prevented mucociliary motility (52). Asthma is associated with changes in the structure and function of the airway epithelium, a key site of SARS-CoV-2 infection (63,64). The altered expression of many asthmatic airway epithelial genes is driven by the type 2 cytokine IL-13 (26). ...
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Article
Asthma is a complex and heterogeneous disease with multicellular involvement, and knowledge gaps remain in our understanding of the pathogenesis of asthma. Efforts are still being made to investigate the immune pathogenesis of asthma in order to identify possible targets for prevention. Single cell RNA sequencing (scRNA-seq) technology is a useful tool for exploring heterogeneous diseases, identifying rare cell types and distinct cell subsets, enabling elucidation of key processes of cell differentiation, and understanding regulatory gene networks that predict immune function. In this article, we provide an overview of the importance of scRNA-seq for asthma research, followed by an in-depth discussion of the results in recent years, in order to provide new ideas for the pathogenesis, drug development and treatment of asthma.
... Previous studies suggested that surface sampling showed that PCR-positivity at high-touch surfaces was associated with nasopharyngeal viral loads and peaked at approximately day 4-5 of symptoms (8)(9)(10)(11). However, in our study, extent of environmental contamination did not correlate with disease course or viral loads. ...
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Article
Background Using daily monitoring of environmental surfaces and personal protective equipment (PPE), we found an increase in environmental contamination since August 18, 2021, in a designated hospital for COVID-19 patients in China, which may lead to an increased risk of exposure to medical staff. Methods To investigate the cause of increased environmental contamination and effect of our intervention, we obtained environmental samples at pre-intervention (August 18–21, 2021) and post-intervention (August 22–28, 2021) from six infection isolation rooms with windows for ventilation and other auxiliary areas at 105 and 129 sites before routine daily cleaning, respectively. In addition, we obtained PPE samples from 98 medical staff exiting the patient rooms/contaminated areas at 482 sites. Between August 22 and 24, 2021, we took measures to reduce environmental contamination based on sampling and inspection results. Findings At pre-intervention, the positivity rates for contamination of environmental surfaces and PPE samples were significantly higher for critical patients (37.21 and 27.86%, respectively) than severely ill patients (25.00 and 12.50%, respectively) and moderately ill patients (0.00 and 0.00%, respectively) (Pearson's Chi-square: χ ² = 15.560, p = 0.000; Fisher's exact test: χ ² = 9.358, p = 0.007). Therefore, we inferred that the source of contamination of environmental surfaces and PPE was mainly the room of critically ill patients, likely through the hands of medical staff to the potentially contaminated areas. A critically ill patient had emergency tracheal intubation and rescue on August 18, 2021, due to worsened patient condition. The ventilator tube used for first aid did not match the ventilator, and the ventilator tube fell off multiple times on August 18–21, 2021, which may explain the increased contamination of environmental surfaces and PPE from critically ill patients, as well as lead to indirect contamination of potentially contaminated areas. The contamination positivity rates of environmental surfaces and PPE were reduced by replacing the appropriate ventilator catheter, limiting the number of people entering the isolation room simultaneously, increasing the frequency of environmental disinfection, standardizing the undressing process, setting up undressing monitoring posts to supervise the undressing process, and preventing the spread of virus infections in the hospital during an epidemic. Conclusions Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was spread on object surfaces in isolation rooms mainly by touch, and the contamination of environmental surfaces and PPE was greater in rooms of patients with greater disease severity and higher surface touch frequency. Therefore, strict protective measures for medical staff, frequent environmental cleaning for isolation rooms, and compliance with mask wearing by patients when conditions permit should be advised to prevent SARS-CoV-2 spread in hospitals.
... First of all, face masks can protect the respiratory system against smog pollution, which in Poland occurs mostly in the autumn and winter [9]. Secondly, due to the global pandemic of SARS-CoV-2, face mask use has become commonplace [10][11][12]. Given the current epidemiological data, there is no indication that the widespread obligation to cover one's mouth and nose with face masks will be lifted any time soon [13]. ...
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Article
The application of phosphorescence for the modification of face mask materials is motivated by the need to appreciably increase their visibility while using graphical elements with a relatively small area. Phosphorescent dyes absorb part of the visible spectrum while emitting radiation at wavelengths that are longer than the absorbed ones. Thus, a phosphorescent substance can emit light even if it is not being illuminated at a given time (but was before). This paper describes studies of the optical properties based on parameters such as the reflectance coefficient, chromaticity coordinates, as well as luminance measured from digital images for two models of smog-protective face half-masks differing in terms of their inner layer with filtration properties and outer printed layer. The external surface of one mask type is printed with a phosphorescent solid star pattern, while the other with a phosphorescent open star pattern. The influence of the inner filter layer was assessed in correlation with the colour of the outer layer and the type of printing. Moreover, the phenomenon of phosphorescence was identified. The study resulted in developing a material with properties providing better visibility under defined use conditions.
... COVID-19 mainly affects the respiratory system and causes a flu-like illness with symptoms such as fever, cough and, in more acute cases, difficulty in breathing. The mortality rate is high in older (>60 years) individuals and people with underlying conditions [7,8]. COVID-19 is not limited to respiratory distress and failure; the virus is now known to emerge as a systemic inflammation that leads to severe cardiac injury, heart failure, sepsis and multi-organ dysfunction in individuals at high risk [3,9]. ...
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It is well known that vital enzymes in the replication process of the coronavirus are the SARS-CoV-2 PLpro and SARS-CoV-2 3CLpro, both of which are important targets in the search for anti-coronavirus agents. These two enzymes are responsible for cleavage at various polyprotein sites in the SARS-CoV-2 lifecycle. Herein, the dynamics of the polyprotein cleavage sequences for the boundary between non-structural proteins Nsp1 and Nsp2 (CS1) and between Nsp2 and Nsp3 (CS2) in complex with both the papain-like protein PLpro and the main protease 3CLpro were explored using computational methods. The post dynamics analysis reveals that CS1 and CS2 both have greater stability when complexed with PLpro. Of these two, greater stability is observed for the CS1–PLpro complex, while destabilization resulting in loss of CS2 from the PLpro active site is observed for CS2-PLpro, suggesting the rate of exchange by the papain-like protease is faster for CS2 compared to CS1. On the other hand, the 3CLpro main protease also reveals stability for CS1 suggesting that the main protease could also play a potential role in the cleavage at point CS1. However, destabilization occurs early in the simulation for the complex CLpro–CS2 suggesting a poor interaction and non-plausible protease cleavage of the polyprotein at CS2 by the main protease. These findings could be used as a guide in the development and design of potent COVID-19 antiviral inhibitors that mimic the CS1 cleavage site.
... Rarely, symptoms of headache/dizziness, breathlessness, muscle or joint pain, diarrhea, nausea, and bloody coughs may occur [10][11][12][13]. A load of SARS-CoV-2 peaks 5-6 days following the start of symptoms, which is remarkably quicker than the SARS-CoV peak, where the virus load peak is about 10 days after symptoms' onset [14][15][16][17]. ...
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Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) that causes COVID-19 disease could progress to Acute Respiratory Distress Syndrome (ARDS). The immune cells' migration in response to the virus leads to cell death by releasing oxidizing free radicals. These oxidizing free radicals mediate NF-κB (Nuclear Factor 'kappa-light-chain-enhancer' of activated B-cells) activation and induce transcription of cytokine-producing genes that eventually causes cytokine storm and septic shock. The over-expression of oxidative stress and enhancing Reactive Oxygen Species (ROS) and Reactive Nitrogen Species (RNS) production activate transcription factors like NF-κB. So repeating this cycle intensifies the host's inflammatory responses. In this way, antioxidants as compounds that inhibit oxidation by terminating chain reactions are suggested to alleviate COVID-19 symptoms. In the present review study, the pathogenesis of the virus, the virus immunopathology, and the balance between immune responses and oxidative stress are discussed. Also, in this review, due to the importance of oxidative stress in the pathogenesis of the disease, some of the most important antioxidant agents whose therapeutic effects have been shown in improving many viral infections, ARDS, and acute lung injury, are recommended to improve the patient's condition infected with SARS-CoV-2. Besides, the recent COVID-19 clinical studies in this field are summarized in this review article. In the present review study, the pathogenesis of the virus, the virus immunopathology, and the balance between immune responses and oxidative stress are discussed. Also, in this review, due to the importance of oxidative stress in the pathogenesis of the disease, some of the most important antioxidant agents whose therapeutic effects have been shown in improving many viral infections, ARDS, and acute lung injury, are recommended to improve the patient's condition infected with SARS-CoV-2. Besides, the recent COVID-19 clinical studies in this field are summarized in this review article. According to these studies, melatonin through promoting sleep quality, decreasing vascular permeability, reducing anxiety, and regulating blood pressure; vitamin C through decreasing the mortality rates and the requirement for mechanical ventilation; glutathione through decreasing respiratory distress in the pneumonia of COVID-19 patients; and high selenium levels could improve the COVID-19 patients' clinical outcomes.
... There are no enough epidemiological facts presently to determine how effortlessly and continuously the virus spreads among human beings, but it's far currently envisioned that one individual with the virus will infect between two and 3 greater people [58]. The virus seems to be transmitted specially via respiration droplets that people sneeze, cough, or exhale. ...
... There are no enough epidemiological facts presently to determine how effortlessly and continuously the virus spreads among human beings, but it's far currently envisioned that one individual with the virus will infect between two and 3 greater people [58]. The virus seems to be transmitted specially via respiration droplets that people sneeze, cough, or exhale. ...
... These people simply are the source of virus transmission (48). The transfer rate of the virus from the respiratory of an asymptomatic contaminated person is equal to that of individuals with clinical symptoms (49). Accordingly, the presence of these individuals in public spaces, especially without ventilation, has caused contamination via bioaerosol droplets during coughing (40). ...
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Context: At the beginning of the COVID-19 pandemic, the effects of personal protective equipment (PPE) such as face masks, as well as environmental conditions, including temperature and humidity changes, were discussed due to the lack of effective medicine. Methods: The preferred reporting items for systematic reviews and meta-analysis (PRISMA) were implemented to conduct the present systematic review. The articles were selected from papers published by May 2020 in PubMed, Web of Science, Science Direct, Scopus, and Google Scholar databases. This meta-analysis estimated relative risk (RR) and pooled mean depicted as effect size (ES) using the random or fixed effects methods. Results: Ten studies met inclusion criteria, four of which addressed the effect of face masks and six of which dealt with temperature and humidity changes. This eta-analysis study showed that wearing face masks against the COVID-19 virus had a remarkable safety impact with RR (%95 CI) 8.56 (2.10 - 34.90), (I2 = %0.0 P = 0.999), and the pooled mean changes in temperature and humidity were estimated to be with ES (%95 CI) 9.03 (4.32 - 13.74), (I2 = %99.7, P = 0.0001) and with ES (%95 CI) 56.82 (46.12 - 67.51), ( I2 = %99.3, P = 0.0001) during the outbreak of the COVID-19. Conclusions: The findings of this systematic review and meta-analysis illustrate the effectiveness of face masks, in general, in preventing the transmission of the COVID-19 virus. According to the findings, temperature and humidity changes do not increase the outbreak of the COVID-19 virus.
... The main port of entry for SARS-CoV-2 in the human body is the nasal cavity, where the first cells infected by the virus are likely the multi-ciliated cells of the nasopharynx or trachea or the sustentacular cells of the nasal olfactory mucosa [2]. As a result, SARS-CoV-2 can be detected in the nasal cavity of both symptomatic as well as asymptomatic COVID-19 patients, where viral titers are reportedly higher than in the throat [3]. ...
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Background: Non-hospitalized patients with asymptomatic or mild/moderate disease account for about 81% of COVID-19 patients, whose upper respiratory tract is affected since the early stages of the infection. Nasal irrigation or aerosol by isotonic or hypertonic saline solution is a traditional therapeutic approach for respiratory or nasal inflammation, also featured by prophylactic properties. Methods: We conducted a prospective open-label controlled study to assess the superiority of an already existing medication (Tonimer Lab Panthexyl 800)—a sterile hypertonic solution containing seawater, xylitol, panthenol and lactic acid—to reduce the viral shedding time in patients affected by asymptomatic or mild COVID-19. COVID-19 patients (N = 108) were split into two groups: a treatment arm (50 participants receiving standard of care plus nasal spray 3 times/day with Tonimer Lab Panthexyl 800) and a control arm (58 participants receiving standard of care but nasal spray with Tonimer Lab Panthexyl 800). The two groups, both testing initially positive for SARS-CoV-2 at real-time PCR (RT-PCR) on nasal swab, were followed up over time to assess the daily number of positive swab tests turning negative (study endpoint). Treatment effectiveness at various time lags since the first positive RT-PCR swab test was measured by rate of events in the experimental arm (EER) and in the control arm (CER), absolute risk increase (ARI) = (EER − CER), and number needed to treat (NNT) = (1/ARI). To investigate the endpoint, we used logistic and Cox regression models, expressing the result as odds ratio (OR) and hazard ratio (HR) with 95% confidence interval (95%CI), respectively. The symptoms recorded with a modified COVID-Q questionnaire at both diagnosis and first negative antigenic swab test were compared in each group (treated versus controls) by exact symmetry test. Results: During the first five days of treatment, COVID-19 patients treated with Tonimer Lab Panthexyl 800 were more likely to become negative two days before controls. According to NNT, four subjects had to be treated for five days to achieve the study endpoint in one individual. The negativization rate in patients treated with Tonimer Lab Panthexyl 800 was significantly higher than patients’ treated with standard of care alone (OR = 7.39, 95%CI: 1.83–29.8; HR = 6.12, 95%CI: 1.76–21.32). There was no evidence of side effects. Conclusions: Nasal spray with Tonimer Lab Panthexyl 800 was effective against SARS-CoV-2, stopping viral shedding in the treatment arm two days before the control group. This treatment should be continued for at least five days after the first positive swab test for SARS-CoV-2.
... Tracheostomy studies.be infected by COVID-19 while examining the patient's upper airway and performing aerosol-generating procedures such as tracheostomies, since the upper airway has high concentration of coronavirus in COVID-19 patients[27]. A study in UK was done on 73 Otorhinolaryngologists who have been infected by COVID-19, over half of them were not wearing PPE and/or infected before Pub-Due to the rapid spreading and emerging cases that needed tracheostomy for prolonged mechanical ventilation, unified and clear guidelines and recommendations for tracheostomies on COVID-19 patients are yet to be established, such Furthermore, The American Academy of Otorhinolaryngology-Head and Neck surgery recommendations are: 1) Tracheostomy in COVID-19 patient should be after 14 days of intubation, with no evidence of optimal time of tracheostomy; 2) Before tracheal incision the patient should be paralyzed, preoxygenated and ventilation held to minimize aerosolization; 3) Minimize electrocautery and suction use; 4) Use cuffed, non-fenestrated tracheostomy tube; 5) Delay tracheostomy tube change until the patient's swab is negative for COVID-19[32].Figure 3. Infection timeline and viral load. ...
... Another risk is linked with the possibility of infection during the time window from the negative test to the time of simulation training. The virus particles could be detected in the nasal and throat swabs of asymptomatic humans [16]. Therefore, we aimed to discover any possible method minimizing extra manipulation with personal protective equipment to enable a safe course of practical lectures, including the BLS training in our Simulation Centre. ...
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Background: Due to the COVID-19 pandemic, Basic Life Support (BLS) training has been limited to compression-only or bag-mask ventilation. The most breathable nanofiber respirators carry the technical possibility for inflation of the mannequin. The aim of this study was to assess the efficacy of mouth-to-mouth breathing through a FFP2 respirator during BLS. Methods: In the cross-over simulation-based study, the medical students performed BLS using a breathable nanofiber respirator for 2 min on three mannequins. The quantitative and qualitative efficacy of mouth-to-mouth ventilation through the respirator in BLS training was analyzed. The primary aim was the effectivity of mouth-to-mouth ventilation through a breathable respirator. The secondary aims were mean pause, longest pause, success in achieving the optimal breath volume, technique of ventilation, and incidence of adverse events. Results: In 104 students, effective breath was reached in 951 of 981 (96.9%) attempts in Adult BLS mannequin (Prestan), 822 of 906 (90.7%) in Resusci Anne, and 1777 of 1857 (95.7%) in Resusci Baby. In Resusci Anne and Resusci Baby, 28.9%/15.9% of visible chest rises were evaluated as low-, 33.0%/44.0% as optimal-, and 28.8%/35.8% as high-volume breaths. Conclusions: Mouth-to-mouth ventilation through a breathable respirator had an effectivity greater than 90%.
... In this study, we evaluated uremic patients under regular chronic dialysis treatment affected by SARS-CoV-2 pneumonia, and a dramatically increased mortality rate compared to the general population (31%) was observed, as expected for CHD patients affected by SARS-CoV-2 pneumonia. Recent evidence showed that the viral load in respiratory specimens of symptomatic patients is similar to that of asymptomatic patients, thus suggesting that the viral load in respiratory specimens may not objectively reflect disease severity [24]. Likewise, the radiological signs of HRCT-proved pneumonia were comparable between patients who experienced clinical worsening and those who were clinically stable. ...
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Background and Objectives: Chronic hemodialysis (CHD) patients are at increased risk of SARS-CoV-2 infection and the related complications and mortality of COVID-19 due to the high rate of comorbidities combined with advanced age. This observational study investigated the clinical manifestations of SARS-CoV-2 infection in CHD and the risk factors for patients′ death. Materials and Methods: The study included 26 CHD patients with SARS-CoV-2 pneumonia detected by positive RT-PCR on nasopharyngeal swabs and high-resolution computed tomography at hospital admission, aged 71 + 5.9 years, 14 of which (53.8%) were male, 20 (77%) under hemodiafiltration, and 6 (23%) on standard hemodialysis, with a median follow-up of 30 days. Results: Simple logistic regression analysis revealed that the factors associated with a higher risk of death were older age (OR: 1.133; 95%CI: 1.028–1.326, p = 0.0057), IL-6 levels at admission (OR: 1.014; 95%CI: 1.004–1.028, p = 0.0053), and C-reactive protein (OR: 1.424; 95%CI: 1.158–2.044, p < 0.0001). In the multiple logistic regression model, circulating IL-6 values at admission remained the only significant prognosticator of death. The ROC curve indicated the discriminatory cut-off value of 38.20 pg/mL of blood IL-6 for predicting death in chronic hemodialysis patients with SARS-CoV-2 pneumonia (sensitivity: 100%; specificity: 78%; AUC: 0.8750; p = 0.0027). Conclusions: This study identified a threshold of IL-6 levels at hospital admission for death risk in CHD patients with SARS-CoV-2 pneumonia. This might represent a valuable outcome predictor, feasibly better than other clinical, radiological, or laboratory parameters and preceding the IL-6 peak, which is unpredictable.
... The severe acute respiratory syndrome coronavirus (SARS-CoV-2) comes under beta-coronaviruses and is one of the seven coronaviruses known to affect humans (Williams, 2020). The SARS-CoV-2 quickly spread throughout the world from its origins in China due to its higher reproductive number, making it more transmissible (Zou et al., 2020). Extrapulmonary manifestations of the virus are now well established, with gastrointestinal, renal, and neurological presentations being the other systems afflicted by it . ...
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Neurodegenerative disorders (NDD) are chronic neurological diseases characterized by loss and/or damage to neurons along with the myelin sheath, and patients are at higher risk of severe infection with the SARS-CoV-2. A comprehensive literature search was performed using relevant terms and inclusion-exclusion criteria. Recent articles, subjects older than 50 years, and articles written in the English language were included, whereas letters to the editor and articles related to pregnant women were excluded from the review study. COVID-19 appears to damage angiotensin-II receptors which cause natural killer cells to lose the ability to clear virus-infected cells, owing to worse outcomes in patients with NDD. COVID-19 can worsen the symptoms of Alzheimer's disease. In addition, COVID-19 worsens drug-responsive motor symptoms in Parkinson's disease (PD) and other symptoms like fatigue and urinary complaints. Vitamin D is essential in decreasing pro-inflammatory and increasing anti-inflammatory cytokines in ongoing COVID-19 infections and reducing angiotensin receptors and, hence, decreasing COVID-19 infection severity. Telemedicine shows promise for patients with NDD but is yet to overcome legal issues and personal barriers. COVID-19 has a significant effect on neurodegenerative conditions, which appears partly to the nature of the NDD and the neuro-invasive capabilities of the SARS-CoV-2. The protective role of vitamin D in patients with NDD further supports this hypothesis. Modifications in current health care, like the telemedicine platform, are required to address the increased risk of serious infection in this population. Further studies will be required to clarify conflicting reports in many fields.
... It was found that anosmia persists in these patients even after recovery for weeks to months, which decreases the quality of life of these patients (3,4). The reason for this can be traced back to the existence of a high viral load within the nasal cavity (5). ...
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Introduction: This study was designed to differentiate between the impact of the topical nasal spray of corticosteroids, antihistamines, a combination of them, and normal 0.2% saline in treating patients with post-coronavirus disease 2019 (COVID-19) smell dysfunction. Materials and methods: Patients with hyposmia or anosmia (n = 240), who recently recovered from COVID-19, were enrolled in this trial and were randomly assigned to four parallel groups. Group I (G1) received a combination of topical corticosteroid and antihistamine nasal spray (n = 60). Group II (G2) received topical corticosteroid nasal spray (n = 60). Group III (G3) received antihistamine nasal spray (n = 60). Group IV (G4) received 0.2% normal nasal saline nasal spray (n = 60). The treatments were used in all groups for 3 weeks. The sense of smell was assessed using the butanol threshold and discrimination tests. The smell tests were evaluated weekly for 3 weeks. Results: The mean age of the patients was 51.9 ± 7.1 years; moreover, 83.8% and 16.2% were male and female, respectively. The results of the smell tests in the first week significantly improved with those in the third week (P< 0.001). The greatest degree of improvement was found in the first group, followed by the second, third, and fourth groups. Conclusions: The results suggest the ability of combination therapy of corticosteroid and antihistamine nasal spray to manage post-COVID-19 hyposmia or anosmia; however, this combination therapy was not superior to corticosteroid nasal spray. Trial registration ID: UMIN000043537.
... El porcentaje de personas infectadas con SARS-CoV-2 con carácter asintomático o presintomático constituye un factor que aún en la actualidad dificulta el control de la pandemia [5][6][7][8] . Se ha reportado que las cargas virales en pacientes asintomáticos y sintomáticos no vacunados son similares 9,10 . Al seguir en contacto con el resto de la población, los individuos asintomáticos pueden transmitir la enfermedad y acelerar la transmisión viral en la comunidad, sobre todo cuando trabajan en lugares cerrados 11 . ...
... [18][19][20] More seriously, it has been reported that the viral load in the asymptomatic patient was similar to that in the symptomatic individuals, suggesting a nonnegligible transmission infectivity and potential. 21 However, these asymptomatic individuals can easily be ignored in epidemic prevention. 22 Measures and methods established for those confirmed in-hospital patients are not FIG. ...
Article
Background: Asymptomatic patients are unneglected sources in propagating transmission chain due to their high viral loads. However, treatments available based on symptoms seem not applicable to asymptomatic patients. In this study, the authors want to estimate the effectiveness of Lianhua Qingwen (LH) capsule on asymptomatic coronavirus disease 2019 (COVID-19) patients. Methods: A randomized controlled trial (RCT) was performed to explore the effectiveness and safety of LH capsule in treating asymptomatic COVID-19 patients. Patients were randomized to control group (isolated observation) and treatment group (LH, 4 capsules, thrice daily) for 14 days. The primary endpoints were the rate and time of nucleic acid turning negative during the isolation observation. Results: A total of 120 participants were included in the full analysis set (60 each in the control and treatment groups). Data showed that the rate of nucleic acid turning negative during the isolation observation in the treatment group was higher than that in the control group (rate difference: 21.66%, 95% confidence interval [CI]: 4.34 to 37.27, p = 0.0142). Patients in the treatment group have a shorter time of nucleic acid turning negative (7.5 vs. 14.5 days, p = 0.018). Moreover, the rate of clinical symptoms appearance in the treatment group was lower compared with that in the control group (rate difference: -31.67, 95% CI: -46.83 to -13.82, p = 0.0005). The proportion of confirmed mild and common cases in the treatment group was also lower (35.00% vs. 66.67%, p = 0.0005). No serious adverse events were documented. Conclusions: In this study, the authors illustrated that LH capsule is beneficial to asymptomatic COVID-19 patients. Considering the lack of interventions for treating asymptomatic COVID-19 patients at this stage, LH capsule could be considered as a choice. Chinese Clinical Trial Registry: ChiCTR2100042066.
... This could prove to play a pivotal role in limiting the spread of the disease as it has already been demonstrated that the disease transmission occurs early after infection, during the incubation period, by asymptomatic carriers, and even during convalescence. [11,12] Abbreviations: SD -Standard Deviation, Df -degrees of freedom, η 2 -partial Eta (effect size). ‡ Indicates a statistically significant value, P<0.05 at 95% CI Upon analyzing the outcomes of this study, we observed that the PvP-I administration produced a statistically significant mean change in the Ct values of serial samples in the test group as compared to the control group. ...
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Background and Objective: The povidone‐iodine (PvP‐I) nasal antiseptic has been shown to completely inactivate the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) in vitro at variable concentrations. This study was performed to investigate the effect of 0.5% PvP‐I nasal drops and oral gargles on the nasopharyngeal and oropharyngeal viral loads in SARS‐CoV‐2‐positive patients. Methods: This was a double‐blind, placebo‐controlled, randomized clinical trial among patients aged ≥18 years with reverse‐transcriptase polymerase chain reaction confirmed in the mild to moderate category of SARS‐CoV‐2 infection. A total of 32 patients were randomly assigned to receive either freshly prepared 0.5% PvP‐I solution or distilled water in the form of supervised self‐administered 4–5 nasal drops, followed by 20 ml for gargling for at least 30 seconds. The main outcome measure was the mean change in viral titer and Ct values in the nasopharyngeal and oropharyngeal samples at baseline, 5 minutes, and 3 hours post intervention. Results: The mean change in viral titers across the time duration for the test group when compared with the control group was not statistically significant (P = 0.109). However, the mean change in Ct value was found to be borderline statistically significant (P = 0.042). Noticeable differences were noted among the mean viral titers and Ct values in the intervention group when plotted against the time of testing as compared to the control group. PvP‐I solution at 0.5% dilution was well tolerated, and no evident side effects were reported. Conclusions: This study shows that 0.5% PvP‐I has an effect on reducing nasopharyngeal and oropharyngeal viral loads in COVID‐19 patients. This can be of substantial aid for the primary care physicians, especially for the practitioners in remote and resource poor areas.
... with the clinical evolution. Viral loads of asymptomatic individuals have been reported to be similar to symptomatic patients [43]. However, in the case of anti-SARS-CoV-2 antibodies, reports suggest a weak immune response in mild clinical cases, as mentioned above. ...
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Background Guidelines on COVID-19 management are developed as we learn from this pandemic. However, most research has been done on hospitalised patients and the impact of the disease on non-hospitalised and their role in transmission are not yet well understood. The COVID HOME study conducts research among COVID-19 patients and their family members who were not hospitalised during acute disease, to guide patient care and inform public health guidelines for infection prevention and control in the community and household. Methods An ongoing prospective longitudinal observational study of COVID-19 outpatients was established in March 2020 at the beginning of the COVID-19 pandemic in the Netherlands. Laboratory confirmed SARS-CoV-2 infected individuals of all ages that did not merit hospitalisation, and their household (HH) members, were enrolled after written informed consent. Enrolled participants were visited at home within 48 hours after initial diagnosis, and then weekly on days 7, 14 and 21 to obtain clinical data, a blood sample for biochemical parameters/cytokines and serological determination; and a nasopharyngeal/throat swab plus urine, stool and sperm or vaginal secretion (if consenting) to test for SARS-CoV-2 by RT-PCR (viral shedding) and for viral culturing. Weekly nasopharyngeal/throat swabs and stool samples, plus a blood sample on days 0 and 21 were also taken from HH members to determine whether and when they became infected. All participants were invited to continue follow-up at 3-, 6-, 12- and 18-months post-infection to assess long-term sequelae and immunological status.
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Introduction COVID-19 has been labelled as pandemic that has spread across many countries in 2020. Otorhinolaryngologists are considered high risk for contracting disease, as the virus resides in the nasal cavity,nasopharynx, and oropharynx. There is an urgent need of safety measures regarding rhinologic practice that need to be clarified both for the current epidemic as well as for future expected “waves”. In this study significant decline was seen in patients viewed physically during pandemic. Nasal endoscopy also became rarer with maximum rhinologists preferring RTPCR before any procedure. Imaging was substituted for endoscopy frequently to adhere to safety protocols relating to OPD rhinologic procedures. We need to discuss these aspects of rhinology as well as practical concerns relating to telemedicine, as these issues take on increasing importance for Rhinologists both in the present and the future. Material and Methods A 27 question survey was designed to assess the present scenario of rhinology practise. The survey was electronically transmitted to rhinologists from 1st November 2020 and their responses were recorded. Result A total of 117 rhinologists responded to the survey. There was significant drop in the number of patients seen by each specialist in the Covid era. There was significant reduction in the number of diagnostic nasal endoscopies performed in clinic daily by the specialists. This study provides an overview of how the COVID-19 pandemic has affected Rhinologic practice. Conclusion Rhinologists need to develop standardized guidelines for their practise. These include protocols pertinent to safety, the substitution of imaging for endoscopy when appropriate, RTPCR test prior to rhinologic procedures, donning of proper PPE and liberal use of telemedicine.
Article
Background: There is growing evidence that coronavirus disease 2019 (COVID-19) can trigger acute episodes of insomnia. Reports on the treatment of COVID-19-related insomnia are limited. Therefore, our study aims to perform a systematic evaluation and meta-analysis of the effects of traditional Chinese exercises (TCEs) in patients with insomnia due to COVID-19. Methods: We will search the Embase, PubMed, Cochrane Library, Web of Science, MEDLINE, Scopus, Chinese Biomedical Literature Database, Chinese National Knowledge Infrastructure Database, and Wan Fang Database from December 1, 2019 to October 2, 2022 to identify all articles on treatment of COVID-19-related insomnia using TCEs. Two researchers will screen the articles and extract the relevant information. Results: The results will provide a systematic overview of the current evidence on the use of TCE to treat patients with insomnia after COVID-19. Conclusions: The conclusions of this study will help clarify the effects of TCEs on patients with insomnia after COVID-19.
Article
The COVID-19 pandemic has required changes in health care practices to decrease the risk of disease transmission during the provision of medical care. The risk of transmission is high in procedures involving the nasopharyngeal and oropharyngeal tissues. This article describes simple preventative strategies at a single institution to minimize the risk of disease transmission during rhinoplasty procedures. In particular, the utility of povidone-iodine in prophylaxis during the perioperative period is discussed.
Article
Objectives There have been limited data on the risk of onward transmission from individuals with Omicron variant infections who return to work after a 5-day isolation. We evaluated the risk of transmission from healthcare workers (HCWs) with Omicron variant who returned to work after a 5-day isolation and the viable virus shedding kinetics. Methods This investigation was performed in a tertiary care hospital, Seoul, South Korea. In a secondary transmission study, we retrospectively reviewed the data of HCWs confirmed as COVID-19 from March 14 to April 3, 2022 in units with 5 or more COVID-19-infected HCWs per week. In the viral shedding kinetics study, HCWs with Omicron variant infection who agreed with daily saliva sampling were enrolled between February and March, 2022. Results Of the 248 HCWs who were diagnosed with COVID-19 within 5 days of the return of an infected HCW, 18 (7%) had contact with the returned HCW within 1 to 5 days after their return. Of these, 9 (4%) had an epidemiologic link other than with the returning HCW, and 9 (4%) had contact with the returning HCW, without any other epidemiologic link. In the study of the kinetics of virus shedding (n=32), the median time from symptom onset to negative conversion of viable virus was 4 days (95% CI, 3 to 5 days). Conclusions Our data suggest that the residual risk of virus transmission after 5 days of isolation following diagnosis or symptom onset is low.
Article
Purpose: Respiratory viral infection increases the number of lung-resident T lymphocytes, which enhance cough sensitivity by producing interferon-γ (IFN-γ). It is poorly understood why IFN-γ-secreting T lymphocytes persist for a long time when the respiratory viruses have been removed. Methods: Repeated pulmonary administration of IFN-γ and intraperitoneal injection with different inhibitors were used to study the effects of pulmonary IFN-γ in mice and guinea pigs. Results: IFN-γ administration caused the increasing of IFN-γ-secreting T lymphocytes in both lung and blood, followed by the elevated physiological level of IFN-γ in the lung, the airway inflammation and the airway epithelial damage. IFN-γ administration also enhanced the cough sensitivity of guinea pigs. IFN-γ activated the STAT1 and extracellular signal-regulated kinase (ERK) pathways in lung tissues, released IFN-γ-inducible protein 10 (IP-10), and resulted in F-actin accumulation in lung-resident lymphocytes. The CXC chemokine receptor 3 (CXCR3) inhibitor potently suppressed all the IFN-γ-induced inflammatory changes. The STAT1 inhibitor mitigated IFN-γ-secreting T lymphocytes infiltration by inhibiting T lymphocytes proliferation. F-actin accumulation and the ERK1/2 pathway contributed to pulmonary IFN-γ-induced augmentation of the airway inflammation and increasing of IFN-γ-secreting T lymphocytes in blood. Conclusions: High physiological levels of IFN-γ in the lung may cause pulmonary lymphocytic inflammation and cough hypersensitivity by increasing the number of IFN-γ-secreting T lymphocytes through the IP-10 and CXCR3 pathways.
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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the associated coronavirus disease 2019 (COVID-19), which severely affect the respiratory system and several organs and tissues, and may lead to death, have shown how science can respond when challenged by a global emergency, offering as a response a myriad of rapid technological developments. Development of vaccines at lightning speed is one of them. SARS-CoV-2 outbreaks have stressed healthcare systems, questioning patients care by using standard non-adapted therapies and diagnostic tools. In this scenario, nanotechnology has offered new tools, techniques and opportunities for prevention, for rapid, accurate and sensitive diagnosis and treatment of COVID-19. In this review, we focus on the nanotechnological applications and nano-based materials (i.e., personal protective equipment) to combat SARS-CoV-2 transmission, infection, organ damage and for the development of new tools for virosurveillance, diagnose and immune protection by mRNA and other nano-based vaccines. All the nano-based developed tools have allowed a historical, unprecedented, real time epidemiological surveillance and diagnosis of SARS-CoV-2 infection, at community and international levels. The nano-based technology has help to predict and detect how this Sarbecovirus is mutating and the severity of the associated COVID-19 disease, thereby assisting the administration and public health services to make decisions and measures for preparedness against the emerging variants of SARS-CoV-2 and severe or lethal COVID-19.
Chapter
Frontline healthcare workers will play a central role in encouraging COVID-19 vaccination. Many studies have found that physicians are the most important influencers of vaccine decision making. To substantially reduce morbidity and mortality from COVID-19, an efficacious and safe vaccine must be delivered swiftly and broadly to the public as soon as it is available. However, the mere availability of a vaccine is insufficient to guarantee broad immunological protection; the vaccine must also be acceptable to both the health community and general public. Vaccine hesitancy is a major barrier to vaccine uptake and the achievement of herd immunity, which is required to protect the most vulnerable populations. Depending on varying biological, environmental, and sociobehavioral factors, the threshold for COVID-19 herd immunity may be between 55% and 82% of the population. This chapter outlines the structure of coronavirus and vaccine development, different approaches of COVID-19 vaccines, whole virus vaccines, protein subunit vaccines, DNA vaccines, and composition of novel corona vaccine. It also illustrates the steps for corona vaccine development with preclinical, clinical evaluation, large-scale production of vaccine, quality control, packaging, storage shipping, and marketing. It describes the key challenges to scale up vaccine production, overcoming key challenges related to vaccine scale-up with business plan for novel corona vaccine.KeywordsCoronavirusAcute respiratory syndromeVaccine developmentHerd immunityDeath rateClinical evaluation
Article
A high-throughput, accurate screening is crucial for the prevention and control of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Current methods, which involve sampling from the nasopharyngeal (NP) area by medical staffs, constitute a fundamental bottleneck in expanding the testing capacity. To meet the scales required for population-level surveillance, self-collectable specimens can be used; however, its low viral load has hindered its clinical adoption. Here, we describe a magnetic nanoparticle functionalized with synthetic apolipoprotein H (ApoH) peptides to capture, concentrate, and purify viruses. The ApoH assay demonstrates a viral enrichment efficiency of >90% for both SARS-CoV-2 and its variants, leading to an order of magnitude improvement in analytical sensitivity. For validation, we apply the assay to a total of 84 clinical specimens including nasal, oral, and mouth gargles obtained from COVID-19 patients. As a result, a 100% positivity rate is achieved from the patient-collected nasal and gargle samples, which exceeds that of the traditional NP swab method. The simple 12 min pre-enrichment assay enabling the use of self-collectable samples will be a practical solution to overcome the overwhelming diagnostic capacity. Furthermore, the methodology can easily be built on various clinical protocols, allowing its broad applicability to various disease diagnoses.
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Background Sepsis patients have the worst outcomes when affected by coronavirus disease 2019 (COVID-19). Unknown are the molecular mechanisms underlying the relationship between sepsis and COVID-19. The primary purpose of the present work was to establish whether there is interaction between COVID-19 and sepsis in terms of molecular perturbation and to uncover a molecular signature, molecular networks, and signaling pathways shared by the two disorders. Methods We retrieved the sepsis and COVID-19 datasets from the Gene Expression Omnibus (GEO) database and used Weighted Gene Co-Expression Network Analysis (WGCNA) to identify key modules. On the common genes residing in the sepsis and COVID-19 associated modules, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were conducted. Then, using the STRING database, we constructed the protein-protein interaction (PPI) network and identified its hub genes. Finally, The immune cell infiltration score and immune-associated pathway activity were calculated using single-sample gene set enrichment analysis (ssGSEA). Results Functional enrichment analysis indicated that antigen processing and presentation of peptide antigen via MHC class I, antigen processing and presentation of peptide antigen, antigen processing and presentation, T cell mediated cytotoxicity and T cell mediated immunity were probably involved in sepsis comorbided with COVID-19. Pathway enrichment analysis of the common genes of key modules identified the underlying biological processes in COVID-19-related sepsis, including Antigen processing and presentation, Phagosome, Natural killer cell mediated cytotoxicity and Adipocytokine signaling pathway. PPI network construction indicated that sepsis comorbided with COVID-19 is likely related to 5 hub genes, including B2M, TNFSF10, TLR3, JAK2, and IRF2. ssGSEA results illustrated that 5 hub genes are closely related to the immune status of sepsis. Conclusions In summary, our work indicated a total of 5 hub genes including B2M, TNFSF10, TLR3, JAK2, and IRF2, which especially underlie the comorbidity mechanisms of sepsis and COVID-19. These shared pathways may give new targets for mechanistic research into the development and management of sepsis and COVID-19.
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Background Information on the long-term pulmonary sequelae following SARS-CoV-2 infection is limited. Methods Prospective cohort study of hospitalized and non-hospitalized adult patients age >18 with documented SARS-CoV-2 infection by RT-PCR three months prior to enrolment between June and December 2020. Participants underwent full pulmonary function test (PFT), cardiopulmonary exercise testing at 3 months and 6 months. Primary outcome was mean differences of forced vital capacity (FVC), diffuse capacity of lung for carbon monoxide (DLCO), and oxygen consumption (VO2) at 6 vs. 3 months. Secondary outcomes were respiratory outcomes classified into 5 clinical groups–no lung disease, resolved lung disease, persistent lung disease, PFT abnormalities attributable to pre-existing lung disease or other factors, and mild PFT abnormalities of uncertain clinical significance. Results Fifty-one, 30 hospitalized and 21 non-hospitalized, participants were included. Median age was 51 years; 20 (39.2%) were female. Mean (±SD) percent predicted values of FVC, DLCO and VO2 at 3 vs 6-month-visits were 96.2 ± 15.6 vs. 97.6 ± 15.5, 73.74 ±18 vs. 78.5 ± 15.5, and 75.5 ± 18.9 vs. 76.1 ± 21.5, respectively. Nineteen (37%) patients had physiologic and/or radiographic evidence of lung disease at 3 months with eight (15.7%) continuing to have persistent disease at 6 months. History of diabetes, hypertension, ICU admission and elevated D-Dimer levels were associated with persistent lung disease at 6 months. Interpretation Persistent lung disease at 6 months post SARS-CoV-2 infection exists. Changes of lung function between 3- and 6-months are not significant. A longer follow-up is required to determine long-term prognosis.
Article
Objective To assess the efficacy of Zafirlukast as a SARS-CoV-2 Helicase Inhibitor in adult patients with moderate COVID-19 symptoms (hospitalized patients with COVID-19 pneumonia who were not admitted to an intensive care unit). Methods We conducted a randomized, double blind, placebo-controlled, pilot trial with adult patients with moderate COVID-19 pneumonia. The sample was randomized to Zafirlukast 10 mg BD for 10 days plus standard care vs placebo plus standard care. The primary outcome was the complete resolution of all symptoms. The secondary outcomes were the duration of oxygen therapy, and length of hospital stay (LOS). Results In total, 40 patients were randomized (20 to Zafirlukast and 20 to the control). The time to the resolution of clinical symptoms in both groups was not significantly different. Regarding the fever, 0.3 days [95% CI, -1.19, 0.69], p = 0.76, for shortness of breath, the difference was 0.4 days [95% CI, -2.67, 3.46], p = 0.68, for cough the difference was 0.2 days [95% CI, -1.45, 1.95], p = 0.98, for sputum the difference was 0.5 days [95% CI, -0.75, 1.85], p = 0.09, for vomiting the difference was 0.1 days [95% CI, -0.50, 0.30], p = 0.93, for fatigue the difference was 0.3 days [95% CI, -4.32, 3.62], p = 0.64. The LOS per day for the two groups was not significantly different, 1.1 days [95% CI,-2.03, 4.28], p = 0.94, nor was the duration of oxygen therapy per days, 1.3 days [95% CI, -1.79, 4.49], p = 0.49. Regarding the 7 category ordinary scale, there was no significant difference between the two groups at day 7 (p-value = 0.62), day 14 (p-value = 0.60) and day 28 (p-value = 0.48). Conclusion Among adult patients hospitalized with COVID-19 pneumonia, the treatment with Zafirlukast, compared to placebo, did not significantly improve symptoms resolution.
Article
Purpose of review: The following article summarizes the current available knowledge regarding tracheostomy techniques, indications, contraindications, procedure timing, use of assisted technologies and tracheostomy feasibility and safety in high-risk populations. In light of the ongoing corona virus disease (COVID-19) pandemic, a focus was placed on tracheostomy in this unique patient group. Recent findings: Percutaneous dilatation tracheostomy (PDT) is commonly used in the ICU setting. It has been shown to be well tolerated and feasible in a diverse patient population including those regarded to be at high risk such as the obese, coagulopathic and acute respiratory failure patient. This patient profile presented itself frequently in the recent COVID-19 pandemic. Indeed studies showed that PDT is well tolerated in COVID-19 ICU patients leading to reduced ICU length of stay (LOS), decrease in ventilator-associated pneumonia rate (VAP) and reduced duration on invasive mechanical ventilation (IMV). Despite initial concerns, virus transmission from patient to healthcare provider (HCP) was shown to be negligible when proper precautions are taken. Summary: Bedside PDT in the ICU is a well tolerated procedure having the potential to benefit both the individual patient as well as to improve resource utilization of the healthcare system.
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