Background: Coronavirus disease 2019 (COVID-19) is a recent global health crisis. One of the major issues of COVID-19 is its unpredictable manifestations and serious outcomes. Many hematological parameters are thought...Background: Coronavirus disease 2019 (COVID-19) is a recent global health crisis. One of the major issues of COVID-19 is its unpredictable manifestations and serious outcomes. Many hematological parameters are thought to change dramatically during the course of the disease. These include white blood cells, red blood cells, and platelets. This study aimed at evaluating certain laboratory results;peripheral blood lymphopenia, relative neutrophilia, high neutrophil-lymphocyte ratio, and elevated C-reactive protein as potential laboratory markers of COVID-19 in Eastern Sudanese patients. Methods: We, retrospectively, aimed at the evaluation of peripheral blood leucocytes count, neutrophil-lymphocyte ratio NLR and C-reactive protein (CRP) levels in confirmed COVID-19 eastern Sudanese patients during the course of the disease. Results: The mean total leucocytes count, % neutrophils count, absolute neutrophils count and C-reactive protein (CRP) were significantly higher (P. value = 0.000) in COVID-19 patients than in the control group while the mean % lymphocytes count and % mixed cells count were found to be significantly lower in COVID-19 patients than in the control group (P. value 0.000). Conclusion: Peripheral blood leucocyte alterations (simultaneous presence of lymphopenia, relative neutrophilia and high neutrophil lymphocyte ratio (NLR) along with elevated CRP levels may be valuable biomarkers associated with COVID-19 in Port Sudan city, Red Sea state, Sudan. These markers might be important in prediction, inspection of disease progression and prognosis.展开更多
As every country in the world struggles with the ongoing COVID-19 pandemic,it is essential that as many people as possible understand the epidemic containment,elimination and exclusion strategies required to tackle it...As every country in the world struggles with the ongoing COVID-19 pandemic,it is essential that as many people as possible understand the epidemic containment,elimination and exclusion strategies required to tackle it.Simplified arithmetic models of COVID-19 transmission,control and elimination are presented in user-friendly Shiny and Excel formats that allow non-specialists to explore,query,critique and understand the containment decisions facing their country and the world at large.Although the predictive model is broadly applicable,the simulations presented are based on parameter values representative of the United Republic of Tanzania,which is still early enough in its epidemic cycle and response to avert a national catastrophe.The predictions of these models illustrate(1)why ambitious lock-down interventions to crush the curve represent the only realistic way for individual countries to contain their national-level epidemics before they turn into outright catastrophes,(2)why these need to be implemented so early,so stringently and for such extended periods,(3)why high prevalence of other pathogens causing similar symptoms to mild COVID-19 precludes the use of contact tracing as a substitute for lock down interventions to contain and eliminate epidemics,(4)why partial containment strategies intended to merely flatten the curve,by maintaining epidemics at manageably low levels,are grossly unrealistic,and(5)why local elimination may only be sustained after lock down ends if imported cases are comprehensively excluded,so international co-operation to conditionally re-open trade and travel between countries certified as free of COVID-19 represents the best strategy for motivating progress towards pandemic eradication at global level.The three sequential goals that every country needs to emphatically embrace are contain,eliminate and exclude.As recently emphasized by the World Health Organization,success will require widespread genuine national unity and unprecedented global solidarity.展开更多
Severe Acute Respiratory Syndrome Coronavirus 1(SARS-CoV-1)infections almost always caused overt symptoms,so effective case and contact management enabled its effective eradication within months.However,Severe Acute R...Severe Acute Respiratory Syndrome Coronavirus 1(SARS-CoV-1)infections almost always caused overt symptoms,so effective case and contact management enabled its effective eradication within months.However,Severe Acute Respiratory Syndrome Coronavirus 2(SARS-CoV-2)usually causes only mild symptoms,so transmission chains may grow to include several individuals before at least one index case becomes ill enough to self-report for diagnosis and care.Here,simple mathematical models were developed to evaluate the implications of delayed index case detection for retrospective contact tracing and management responses.Specifically,these simulations illustrate how:(1)Contact tracing and management may effectively contain most but not all large SARS-CoV-2 clusters arising at foci with high reproduction numbers because rapidly expanding transmission chains ensure at least one overtly symptomatic index case occurs within two viral generations a week or less apart.(2)However,lower reproduction numbers give rise to thinner transmission chains extending through longer sequences of non-reporting asymptomatic and paucisymptomatic individuals,often spanning three or more viral generations(2 weeks of transmission)before an overtly symptomatic index case occurs.(3)Consequently,it is not always possible to fully trace and contain such long,thin transmission chains,so the community transmission they give rise to is underrepresented in surveillance data.(4)Wherever surveillance systems are weak and/or transmission proceeds within population groups with lower rates of overt clinical symptoms and/or self-reporting,case and contact management effectiveness may be more severely limited,even at the higher reproduction numbers associated with larger outbreaks.(5)Because passive surveillance platforms may be especially slow to detect the thinner transmission chains that occur at low reproduction numbers,establishing satisfactory confidence of elimination may require that no confirmed cases are detected for two full months,throughout which presump展开更多
Countries with ambitious national strategies to crush the curve of their Severe Acute Respiratory Syndrome Coronavirus 2(SARS-CoV-2)epidemic trajectories include China,Korea,Japan,Taiwan,New Zealand and Australia.Howe...Countries with ambitious national strategies to crush the curve of their Severe Acute Respiratory Syndrome Coronavirus 2(SARS-CoV-2)epidemic trajectories include China,Korea,Japan,Taiwan,New Zealand and Australia.However,the United States and many hard-hit European countries,like Ireland,Italy,Spain,France and the United Kingdom,currently appear content to merely flatten the curve of their epidemic trajectories so that transmission persists at rates their critical care services can cope with.Here I present a simple set of arithmetic modelling analyses that are accessible to non-specialists and explain why preferable crush the curve strategies,to eliminate transmission within months,would require only a modest amount of additional containment effort relative to the tipping point targeted by flatten the curve strategies,which allow epidemics to persist at supposedly steady,manageable levels for years,decades or even indefinitely.展开更多
The virus SARS-CoV2,which causes the Coronavirus disease COVID-19 has become a pandemic and has spread to every inhabited continent.Given the increasing caseload,there is an urgent need to augment clinical skills in o...The virus SARS-CoV2,which causes the Coronavirus disease COVID-19 has become a pandemic and has spread to every inhabited continent.Given the increasing caseload,there is an urgent need to augment clinical skills in order to identify from among the many mild cases the few that will progress to critical illness.We present a first step towards building an artificial intelligence(AI)framework,with predictive analytics(PA)capabilities applied to real patient data,to provide rapid clinical decision-making support.COVID-19 has presented a pressing need as a)clinicians are still developing clinical acumen given the disease’s novelty,and b)resource limitations in a rapidly expanding pandemic require difficult decisions relating to resource allocation.The objectives of this research are:(1)to algorithmically identify the combinations of clinical characteristics of COVID-19 that predict outcomes,and(2)to develop a tool with AI capabilities that will predict patients at risk for more severe illness on initial presentation.The predictive models learn from historical data to help predict specifically who will develop acute respiratory distress syndrome(ARDS),a severe outcome in COVID-19.Our experimental results based on two hospitals in Wenzhou,Zhejang,China identify features most predictive of ARDS in COVID-19 initial presentation which would not have stood out to clinicians.A mild increase in elevated alanine aminotransferase(ALT)(a liver enzyme)),a presence of myalgias(body aches),and an increase in hemoglobin,in this order,are the clinical features,on presentation,that are the most predictive.Those two centers’COVID-19 case series symptoms on initial presentation can help predict severe outcomes.Predictive models that learned from historical data of patients from two Chinese hospitals achieved 70%to 80%accuracy in predicting severe cases.展开更多
Infection caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV2)virus,responsible for the coronavirus disease 2019(COVID-19)pandemic,induces symptoms including increased inflammatory response,severe ...Infection caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV2)virus,responsible for the coronavirus disease 2019(COVID-19)pandemic,induces symptoms including increased inflammatory response,severe acute respiratory syndrome(SARS),cognitive dysfunction like brain fog,and cardiovascular defects.Long-term effects of SARS-CoV2 COVID-19 syndrome referred to as post-COVID-19 syndrome on age-related progressive neurodegenerative disorders such as Alzheimer's disease remain understudied.Using the targeted misexpression of individual SARS-CoV2 proteins in the retinal neurons of the Drosophila melanogaster eye,we found that misexpression of nonstructural protein 3(Nsp3),a papain-like protease,ablates the eye and generates dark necrotic spots.Targeted misexpression of Nsp3 in the eye triggers reactive oxygen species production and leads to apoptosis as shown by cell death reporters,terminal deoxynucleotidyl transferase(TdT)dUTP Nick-end labeling(TUNEL)assay,and dihydroethidium staining.Furthermore,Nsp3 misexpression activates both apoptosis and autophagy mechanism(s)to regulate tissue homeostasis.Transient expression of SARS-CoV2 Nsp3 in murine neuroblastoma,Neuro-2a cells,significantly reduced the metabolic activity of these cells and triggers cell death.Misexpression of SARS-CoV2 Nsp3 in an Alzheimer's disease transgenic fly eye model(glass multiple repeats[GMR]>amyloidβ42)further enhances the neurodegenerative rough eye phenotype due to increased cell death.These findings suggest that SARS-CoV2 utilizes Nsp3 protein to potentiate cell death response in a neurodegenerative disease background that has high pre-existing levels of neuroinflammation and cell death.展开更多
Obesity and type 2 diabetes are among the most important risk factors for severe coronavirus disease-19. Some studies have suggested that the use of insulin as a therapeutic agent to treat hyperglycemia and the metabo...Obesity and type 2 diabetes are among the most important risk factors for severe coronavirus disease-19. Some studies have suggested that the use of insulin as a therapeutic agent to treat hyperglycemia and the metabolic abnormalities associated with type 2 diabetes during the acute phase of severe coronavirus disease-19 could have a negative impact on the disease’s progression;however, there is no consensus on this issue. Here, we performed a systematic review in an attempt to answer this important question. We included 29 articles published from December 2019 to August 2023, which reported the outcomes of 3,070,657 patients with severe coronavirus disease-19 that had the diagnosis of diabetes and were treated with either insulin or other glucose-reducing agents. The results show that using insulin as a pharmacological intervention to treat type 2 diabetes in patients with severe coronavirus disease-19 increases the likelihood of mortality by 193%.展开更多
Context: COVID-19 can spread rapidly in haemodialysis centres, leading to fatal outcomes. Implementing physical measures is crucial in limiting the spread of infection. Aims: To assess adherence to physical measures a...Context: COVID-19 can spread rapidly in haemodialysis centres, leading to fatal outcomes. Implementing physical measures is crucial in limiting the spread of infection. Aims: To assess adherence to physical measures against SARS-Cov2 in haemodialysis patients. Methods and Material: From 13 to 19 July 2021, we administered the questionnaire to haemodialysis patients during or immediately after the dialysis session. The dependent variables were adherence to wearing masks, hand washing outside the dialysis centre, social distancing of at least 1.5 meters, and cough and sneeze hygiene. Statistical Analysis Used: Data were analyzed using Epi info software;descriptive statistics were presented as mean, headcount, and percentage;related factors were determined by multi-logistic regression. The significance level was 5%. The Health Research Ethics Committee approved the research protocol. Results: 142 patients were included (mean age: 42.5 ± 14 years). Wearing masks, hand-washing, social distancing, and coughing and sneezing hygiene were observed by 88%, 75%, 47%, and 60% of patients, respectively. Conclusion: Wearing masks was the most respected physical measure, while social distancing was the least respected.展开更多
Introduction: Following the COVID-19 pandemic, vaccination has been proposed in several countries as the main preventive measure despite very limited data, particularly in dialysis patients. We conducted this study to...Introduction: Following the COVID-19 pandemic, vaccination has been proposed in several countries as the main preventive measure despite very limited data, particularly in dialysis patients. We conducted this study to assess the immunological response to vaccination in Senegalese hemodialysis patients. Patients and Methods: We conducted a prospective study, in two dialysis centers in Dakar from March 30<sup>th</sup> to August 30<sup>th</sup>, 2021 including patients on hemodialysis for >6 months, vaccinated against SARS-CoV-2 according to the vaccination schedule recommended by WHO. A vaccine response was considered positive when seroconversion was observed after one dose of vaccine. The clinical efficacy of immunization was defined as the absence of new COVID-19 infection in patients who received a complete vaccination. Results: Among the 81 patients included in the study, 7.4% had anti-Spike IgM antibodies before their first vaccination. Seroprevalence of IgM antibodies was 38.3% one month after the first vaccine dose (at M1) and 8.6% one month after the second dose (at M4). Anti-Spike IgG antibodies were present in 40.3% of patients before vaccination, in 90.1% at M1, and in 59.7% at M4. Among patients previously infected with SARS-CoV-2, 10.2% had IgM antibodies at M0, 31.6% at M1, and 10.5% at M4 post-vaccination. Similarly, seroprevalences of IgG antibodies in this subgroup were 31.5%, 61.3%, and 50.0% respectively at M0, M1, and M4 post-vaccination. A comparison of seroconversion rates between M0 and M4 showed significant differences only for IgG in COVID-19 naive patients. Mean duration in dialysis and the existence of previous COVID-19 infection were associated with patients’ vaccinal response after the two doses. Age, gender and the use of immunosuppressive treatment did not influence post-vaccinal antibody production. Conclusion: Vaccination against COVID-19 in Senegalese hemodialysis patients induced a low seroconversion rate but it was well tolerated. Moreover, the induced protection was neither st展开更多
Introduction: Covid-19 is a systemic disease that can spread to all systems. Among the gastrointestinal manifestations, pancreatic involvement can have a major prognostic impact. We report 3 acute pancreatitis cases o...Introduction: Covid-19 is a systemic disease that can spread to all systems. Among the gastrointestinal manifestations, pancreatic involvement can have a major prognostic impact. We report 3 acute pancreatitis cases occurring during Covid-19, in Dakar. Case 1: 65-year-old woman who presented with intense atypical epigastric pain. Physical examination revealed obesity, high blood pressure and abdominal tenderness. Biological tests found increase CRP (134 mg/l) and lipasemia (312 UI/l). Abdominal CT scan showed findings of Balthazar grade C acute pancreatitis. RT-PCR for SARS CoV 2 RT-PCR was positive. The outcome was favorable. Case 2: 56-year-old woman patient with history of nephroangiosclerosis who presented with dyspnea, cough, fever and moderate epigastric pain. Physical examination revealed epigastric tenderness, high blood pressure, anuria. Biological testing, noted increase CRP (96 mg/l), lipasemia (793 UI/l), creatinine (227 mg/l) and urea (3.84 g/l). Abdominal CT scan showed acute edematous pancreatitis findings. SARS CoV 2 RT PCR was positive. The outcome was favorable. Case 3: 27-year-old man who presented with physical asthenia, headache, and epigastric pain. Physical examination found epigastric tenderness. Elevated CRP level was of 102 mg/l and lipasemia level was of 427 UI/l (7N). Abdominal CT scan showed acute edematous pancreatitis findings. SARS CoV 2 RT PCR was positive. The outcome was favorable. Conclusion: Acute pancreatitis can occur during Covid-19 infection. However, the imputability to the Covid-19 disease necessitates to rule out the most common causes.展开更多
Introduction: Morocco has experienced, like the whole world, the COVID-19 pandemic. Until the writing of this article, a subjective observation of the increase in the number of anencephaly has been observed in our fac...Introduction: Morocco has experienced, like the whole world, the COVID-19 pandemic. Until the writing of this article, a subjective observation of the increase in the number of anencephaly has been observed in our facility. And since the teratogenic potential of the SARS Cov 2 virus is not sufficiently documented, we wondered if there would be a relationship between the relatively high number of anencephalic fetuses and COVID-19 infection. Aim: the objective of the study is to look for a possible correlation between the period of conception of these anencephalies and the pandemic. Material and methods: This is a retrospective study (from June 1, 2020 to May 31, 2022 in the Obstetrics Gynecology department, Faculty of Medicine and Pharmacy, CADI AYYAD UNIVERSITY Marrakech Morocco) consisting of the analysis of the number of patients in the target embryonic period (namely the closure of the neural tube: D18 to D30 of embryonic life) compared to the reference curves of the evolution of the SARS Cov2 pandemic. Results: The analysis of the number of patients at the target embryonic phase shows that many of our anencephalons (63%) were conceived during periods of high diffusion of the SARS Cov 2 virus in Morocco. Conclusion: Our study suggests a relationship between the COVID-19 pandemic and the occurrence of anencephaly, we cannot, however, highlight the type of direct or indirect relationship that binds them. Therefore, further studies should be considered to better investigate this relationship.展开更多
<strong>Background:</strong> The prevalence of SARS-COV2 in Libya is unclear;PCR is still under-performed. Although lockdown measures have been in place for weeks, there is no prevalence data to support th...<strong>Background:</strong> The prevalence of SARS-COV2 in Libya is unclear;PCR is still under-performed. Although lockdown measures have been in place for weeks, there is no prevalence data to support the gradual lifting of such lockdowns. SARS-COV2 IgM/IgG is emerging as potential alternatives to PCR testing, and many counties and towns have undertaken such seroprevalence studies. <strong>Objective:</strong> Prevalence of SARS-COV2 in Misrata, Libya amongst the population as a whole. <strong>Materials and Methods:</strong> The study was prospective, cross-sectional, population-based, and age-stratified, to assess SARS-COV2 IgM/IgG in the population of Misrata. It was carried out between the 18th and 21st of April, 2020. <strong>Results: </strong>A representative sample of 897 participants was tested for SARS-COV2 IgM/IgG antibodies. 30 participants were positive for IgM or IgG indicating a prevalence of 3.4% (95% CI, 2.8% - 5.2%), with eight (0.9%) IgM positive and 22 (2.4%) IgG positive. Accordingly, 9075 (95% CI, 6586 - 14,170) people are estimated to have had a current or recent COVID-19 infection, symptomatic or asymptomatic. <strong>Conclusion and Recommendations:</strong> Serological testing as a diagnostic or surveillance tool may uncover a large proportion of asymptomatic individuals in the community, far outnumbering PCR. The authors highly recommend further precautionary public measures, as well as an ongoing surveillance programme to monitor the epidemiological trends of the disease in the city of Misrata and Libya in general.展开更多
Introduction and Objectives: Since its advent in 2019, Corona Virus Disease 19 (Covid-19) has changed everyday life in many unprecedented ways. With the availability of Covid-19 vaccines, clinical practice has stepped...Introduction and Objectives: Since its advent in 2019, Corona Virus Disease 19 (Covid-19) has changed everyday life in many unprecedented ways. With the availability of Covid-19 vaccines, clinical practice has stepped gradually towards its everyday routine. The clinician, however, needs to address such concerns as “Can Covid-19 present with urinary tract symptoms predominantly?”, “Can the urinary tract develop long-term Covid-19 symptoms?”, “Can Covid-19 vaccines/drug therapy cause male infertility?” Methods: This mini-review of the current literature has been carried out by searching the Pubmed database. Results and Conclusions: Our literature review suggests that there is insufficient evidence to conclude a significant impact on the urinary tract from Covid-19 infection. There is supporting evidence that mRNA anti-SARS-CoV-2 vaccines are safe for male gonads. Research to further support these conclusions is required.展开更多
文摘Background: Coronavirus disease 2019 (COVID-19) is a recent global health crisis. One of the major issues of COVID-19 is its unpredictable manifestations and serious outcomes. Many hematological parameters are thought to change dramatically during the course of the disease. These include white blood cells, red blood cells, and platelets. This study aimed at evaluating certain laboratory results;peripheral blood lymphopenia, relative neutrophilia, high neutrophil-lymphocyte ratio, and elevated C-reactive protein as potential laboratory markers of COVID-19 in Eastern Sudanese patients. Methods: We, retrospectively, aimed at the evaluation of peripheral blood leucocytes count, neutrophil-lymphocyte ratio NLR and C-reactive protein (CRP) levels in confirmed COVID-19 eastern Sudanese patients during the course of the disease. Results: The mean total leucocytes count, % neutrophils count, absolute neutrophils count and C-reactive protein (CRP) were significantly higher (P. value = 0.000) in COVID-19 patients than in the control group while the mean % lymphocytes count and % mixed cells count were found to be significantly lower in COVID-19 patients than in the control group (P. value 0.000). Conclusion: Peripheral blood leucocyte alterations (simultaneous presence of lymphopenia, relative neutrophilia and high neutrophil lymphocyte ratio (NLR) along with elevated CRP levels may be valuable biomarkers associated with COVID-19 in Port Sudan city, Red Sea state, Sudan. These markers might be important in prediction, inspection of disease progression and prognosis.
基金No funding was received from any source for the preparation of this article but GFK is supported by an AXA Research Chair award and Irish Aid(Department of Foreign Affairs and Trade,Government of Ireland)supported the open access publication costs of the study through the Embassy of Ireland in Tanzania(Award number AI-TAN/2020/086)The ideas,opinions and comments of the authors are entirely their own responsibility and do not necessarily represent or reflect Irish Aid policy.
文摘As every country in the world struggles with the ongoing COVID-19 pandemic,it is essential that as many people as possible understand the epidemic containment,elimination and exclusion strategies required to tackle it.Simplified arithmetic models of COVID-19 transmission,control and elimination are presented in user-friendly Shiny and Excel formats that allow non-specialists to explore,query,critique and understand the containment decisions facing their country and the world at large.Although the predictive model is broadly applicable,the simulations presented are based on parameter values representative of the United Republic of Tanzania,which is still early enough in its epidemic cycle and response to avert a national catastrophe.The predictions of these models illustrate(1)why ambitious lock-down interventions to crush the curve represent the only realistic way for individual countries to contain their national-level epidemics before they turn into outright catastrophes,(2)why these need to be implemented so early,so stringently and for such extended periods,(3)why high prevalence of other pathogens causing similar symptoms to mild COVID-19 precludes the use of contact tracing as a substitute for lock down interventions to contain and eliminate epidemics,(4)why partial containment strategies intended to merely flatten the curve,by maintaining epidemics at manageably low levels,are grossly unrealistic,and(5)why local elimination may only be sustained after lock down ends if imported cases are comprehensively excluded,so international co-operation to conditionally re-open trade and travel between countries certified as free of COVID-19 represents the best strategy for motivating progress towards pandemic eradication at global level.The three sequential goals that every country needs to emphatically embrace are contain,eliminate and exclude.As recently emphasized by the World Health Organization,success will require widespread genuine national unity and unprecedented global solidarity.
基金GFK is supported by an AXA Research Chair award funded by the AXA Research Fund and the College of Science,Engineering and Food Science at University College Cork.
文摘Severe Acute Respiratory Syndrome Coronavirus 1(SARS-CoV-1)infections almost always caused overt symptoms,so effective case and contact management enabled its effective eradication within months.However,Severe Acute Respiratory Syndrome Coronavirus 2(SARS-CoV-2)usually causes only mild symptoms,so transmission chains may grow to include several individuals before at least one index case becomes ill enough to self-report for diagnosis and care.Here,simple mathematical models were developed to evaluate the implications of delayed index case detection for retrospective contact tracing and management responses.Specifically,these simulations illustrate how:(1)Contact tracing and management may effectively contain most but not all large SARS-CoV-2 clusters arising at foci with high reproduction numbers because rapidly expanding transmission chains ensure at least one overtly symptomatic index case occurs within two viral generations a week or less apart.(2)However,lower reproduction numbers give rise to thinner transmission chains extending through longer sequences of non-reporting asymptomatic and paucisymptomatic individuals,often spanning three or more viral generations(2 weeks of transmission)before an overtly symptomatic index case occurs.(3)Consequently,it is not always possible to fully trace and contain such long,thin transmission chains,so the community transmission they give rise to is underrepresented in surveillance data.(4)Wherever surveillance systems are weak and/or transmission proceeds within population groups with lower rates of overt clinical symptoms and/or self-reporting,case and contact management effectiveness may be more severely limited,even at the higher reproduction numbers associated with larger outbreaks.(5)Because passive surveillance platforms may be especially slow to detect the thinner transmission chains that occur at low reproduction numbers,establishing satisfactory confidence of elimination may require that no confirmed cases are detected for two full months,throughout which presump
基金This study was supported by an AXA Research Chair award to the author,kindly provided by the AXA Research Fund,and by Irish Aid,Deparment of Foreign Affairs and Trade,Government of Ireland through the Embassy of Ireland in Tanzania(Award number IA-TAN/2020/086).
文摘Countries with ambitious national strategies to crush the curve of their Severe Acute Respiratory Syndrome Coronavirus 2(SARS-CoV-2)epidemic trajectories include China,Korea,Japan,Taiwan,New Zealand and Australia.However,the United States and many hard-hit European countries,like Ireland,Italy,Spain,France and the United Kingdom,currently appear content to merely flatten the curve of their epidemic trajectories so that transmission persists at rates their critical care services can cope with.Here I present a simple set of arithmetic modelling analyses that are accessible to non-specialists and explain why preferable crush the curve strategies,to eliminate transmission within months,would require only a modest amount of additional containment effort relative to the tipping point targeted by flatten the curve strategies,which allow epidemics to persist at supposedly steady,manageable levels for years,decades or even indefinitely.
文摘The virus SARS-CoV2,which causes the Coronavirus disease COVID-19 has become a pandemic and has spread to every inhabited continent.Given the increasing caseload,there is an urgent need to augment clinical skills in order to identify from among the many mild cases the few that will progress to critical illness.We present a first step towards building an artificial intelligence(AI)framework,with predictive analytics(PA)capabilities applied to real patient data,to provide rapid clinical decision-making support.COVID-19 has presented a pressing need as a)clinicians are still developing clinical acumen given the disease’s novelty,and b)resource limitations in a rapidly expanding pandemic require difficult decisions relating to resource allocation.The objectives of this research are:(1)to algorithmically identify the combinations of clinical characteristics of COVID-19 that predict outcomes,and(2)to develop a tool with AI capabilities that will predict patients at risk for more severe illness on initial presentation.The predictive models learn from historical data to help predict specifically who will develop acute respiratory distress syndrome(ARDS),a severe outcome in COVID-19.Our experimental results based on two hospitals in Wenzhou,Zhejang,China identify features most predictive of ARDS in COVID-19 initial presentation which would not have stood out to clinicians.A mild increase in elevated alanine aminotransferase(ALT)(a liver enzyme)),a presence of myalgias(body aches),and an increase in hemoglobin,in this order,are the clinical features,on presentation,that are the most predictive.Those two centers’COVID-19 case series symptoms on initial presentation can help predict severe outcomes.Predictive models that learned from historical data of patients from two Chinese hospitals achieved 70%to 80%accuracy in predicting severe cases.
基金supported by 1RO1EY032959-01 from NIHSchuellein Chair Endowment FundSTEM Catalyst Grant from the University of Dayton(all to AS)。
文摘Infection caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV2)virus,responsible for the coronavirus disease 2019(COVID-19)pandemic,induces symptoms including increased inflammatory response,severe acute respiratory syndrome(SARS),cognitive dysfunction like brain fog,and cardiovascular defects.Long-term effects of SARS-CoV2 COVID-19 syndrome referred to as post-COVID-19 syndrome on age-related progressive neurodegenerative disorders such as Alzheimer's disease remain understudied.Using the targeted misexpression of individual SARS-CoV2 proteins in the retinal neurons of the Drosophila melanogaster eye,we found that misexpression of nonstructural protein 3(Nsp3),a papain-like protease,ablates the eye and generates dark necrotic spots.Targeted misexpression of Nsp3 in the eye triggers reactive oxygen species production and leads to apoptosis as shown by cell death reporters,terminal deoxynucleotidyl transferase(TdT)dUTP Nick-end labeling(TUNEL)assay,and dihydroethidium staining.Furthermore,Nsp3 misexpression activates both apoptosis and autophagy mechanism(s)to regulate tissue homeostasis.Transient expression of SARS-CoV2 Nsp3 in murine neuroblastoma,Neuro-2a cells,significantly reduced the metabolic activity of these cells and triggers cell death.Misexpression of SARS-CoV2 Nsp3 in an Alzheimer's disease transgenic fly eye model(glass multiple repeats[GMR]>amyloidβ42)further enhances the neurodegenerative rough eye phenotype due to increased cell death.These findings suggest that SARS-CoV2 utilizes Nsp3 protein to potentiate cell death response in a neurodegenerative disease background that has high pre-existing levels of neuroinflammation and cell death.
文摘Obesity and type 2 diabetes are among the most important risk factors for severe coronavirus disease-19. Some studies have suggested that the use of insulin as a therapeutic agent to treat hyperglycemia and the metabolic abnormalities associated with type 2 diabetes during the acute phase of severe coronavirus disease-19 could have a negative impact on the disease’s progression;however, there is no consensus on this issue. Here, we performed a systematic review in an attempt to answer this important question. We included 29 articles published from December 2019 to August 2023, which reported the outcomes of 3,070,657 patients with severe coronavirus disease-19 that had the diagnosis of diabetes and were treated with either insulin or other glucose-reducing agents. The results show that using insulin as a pharmacological intervention to treat type 2 diabetes in patients with severe coronavirus disease-19 increases the likelihood of mortality by 193%.
文摘Context: COVID-19 can spread rapidly in haemodialysis centres, leading to fatal outcomes. Implementing physical measures is crucial in limiting the spread of infection. Aims: To assess adherence to physical measures against SARS-Cov2 in haemodialysis patients. Methods and Material: From 13 to 19 July 2021, we administered the questionnaire to haemodialysis patients during or immediately after the dialysis session. The dependent variables were adherence to wearing masks, hand washing outside the dialysis centre, social distancing of at least 1.5 meters, and cough and sneeze hygiene. Statistical Analysis Used: Data were analyzed using Epi info software;descriptive statistics were presented as mean, headcount, and percentage;related factors were determined by multi-logistic regression. The significance level was 5%. The Health Research Ethics Committee approved the research protocol. Results: 142 patients were included (mean age: 42.5 ± 14 years). Wearing masks, hand-washing, social distancing, and coughing and sneezing hygiene were observed by 88%, 75%, 47%, and 60% of patients, respectively. Conclusion: Wearing masks was the most respected physical measure, while social distancing was the least respected.
文摘Introduction: Following the COVID-19 pandemic, vaccination has been proposed in several countries as the main preventive measure despite very limited data, particularly in dialysis patients. We conducted this study to assess the immunological response to vaccination in Senegalese hemodialysis patients. Patients and Methods: We conducted a prospective study, in two dialysis centers in Dakar from March 30<sup>th</sup> to August 30<sup>th</sup>, 2021 including patients on hemodialysis for >6 months, vaccinated against SARS-CoV-2 according to the vaccination schedule recommended by WHO. A vaccine response was considered positive when seroconversion was observed after one dose of vaccine. The clinical efficacy of immunization was defined as the absence of new COVID-19 infection in patients who received a complete vaccination. Results: Among the 81 patients included in the study, 7.4% had anti-Spike IgM antibodies before their first vaccination. Seroprevalence of IgM antibodies was 38.3% one month after the first vaccine dose (at M1) and 8.6% one month after the second dose (at M4). Anti-Spike IgG antibodies were present in 40.3% of patients before vaccination, in 90.1% at M1, and in 59.7% at M4. Among patients previously infected with SARS-CoV-2, 10.2% had IgM antibodies at M0, 31.6% at M1, and 10.5% at M4 post-vaccination. Similarly, seroprevalences of IgG antibodies in this subgroup were 31.5%, 61.3%, and 50.0% respectively at M0, M1, and M4 post-vaccination. A comparison of seroconversion rates between M0 and M4 showed significant differences only for IgG in COVID-19 naive patients. Mean duration in dialysis and the existence of previous COVID-19 infection were associated with patients’ vaccinal response after the two doses. Age, gender and the use of immunosuppressive treatment did not influence post-vaccinal antibody production. Conclusion: Vaccination against COVID-19 in Senegalese hemodialysis patients induced a low seroconversion rate but it was well tolerated. Moreover, the induced protection was neither st
文摘Introduction: Covid-19 is a systemic disease that can spread to all systems. Among the gastrointestinal manifestations, pancreatic involvement can have a major prognostic impact. We report 3 acute pancreatitis cases occurring during Covid-19, in Dakar. Case 1: 65-year-old woman who presented with intense atypical epigastric pain. Physical examination revealed obesity, high blood pressure and abdominal tenderness. Biological tests found increase CRP (134 mg/l) and lipasemia (312 UI/l). Abdominal CT scan showed findings of Balthazar grade C acute pancreatitis. RT-PCR for SARS CoV 2 RT-PCR was positive. The outcome was favorable. Case 2: 56-year-old woman patient with history of nephroangiosclerosis who presented with dyspnea, cough, fever and moderate epigastric pain. Physical examination revealed epigastric tenderness, high blood pressure, anuria. Biological testing, noted increase CRP (96 mg/l), lipasemia (793 UI/l), creatinine (227 mg/l) and urea (3.84 g/l). Abdominal CT scan showed acute edematous pancreatitis findings. SARS CoV 2 RT PCR was positive. The outcome was favorable. Case 3: 27-year-old man who presented with physical asthenia, headache, and epigastric pain. Physical examination found epigastric tenderness. Elevated CRP level was of 102 mg/l and lipasemia level was of 427 UI/l (7N). Abdominal CT scan showed acute edematous pancreatitis findings. SARS CoV 2 RT PCR was positive. The outcome was favorable. Conclusion: Acute pancreatitis can occur during Covid-19 infection. However, the imputability to the Covid-19 disease necessitates to rule out the most common causes.
文摘Introduction: Morocco has experienced, like the whole world, the COVID-19 pandemic. Until the writing of this article, a subjective observation of the increase in the number of anencephaly has been observed in our facility. And since the teratogenic potential of the SARS Cov 2 virus is not sufficiently documented, we wondered if there would be a relationship between the relatively high number of anencephalic fetuses and COVID-19 infection. Aim: the objective of the study is to look for a possible correlation between the period of conception of these anencephalies and the pandemic. Material and methods: This is a retrospective study (from June 1, 2020 to May 31, 2022 in the Obstetrics Gynecology department, Faculty of Medicine and Pharmacy, CADI AYYAD UNIVERSITY Marrakech Morocco) consisting of the analysis of the number of patients in the target embryonic period (namely the closure of the neural tube: D18 to D30 of embryonic life) compared to the reference curves of the evolution of the SARS Cov2 pandemic. Results: The analysis of the number of patients at the target embryonic phase shows that many of our anencephalons (63%) were conceived during periods of high diffusion of the SARS Cov 2 virus in Morocco. Conclusion: Our study suggests a relationship between the COVID-19 pandemic and the occurrence of anencephaly, we cannot, however, highlight the type of direct or indirect relationship that binds them. Therefore, further studies should be considered to better investigate this relationship.
文摘<strong>Background:</strong> The prevalence of SARS-COV2 in Libya is unclear;PCR is still under-performed. Although lockdown measures have been in place for weeks, there is no prevalence data to support the gradual lifting of such lockdowns. SARS-COV2 IgM/IgG is emerging as potential alternatives to PCR testing, and many counties and towns have undertaken such seroprevalence studies. <strong>Objective:</strong> Prevalence of SARS-COV2 in Misrata, Libya amongst the population as a whole. <strong>Materials and Methods:</strong> The study was prospective, cross-sectional, population-based, and age-stratified, to assess SARS-COV2 IgM/IgG in the population of Misrata. It was carried out between the 18th and 21st of April, 2020. <strong>Results: </strong>A representative sample of 897 participants was tested for SARS-COV2 IgM/IgG antibodies. 30 participants were positive for IgM or IgG indicating a prevalence of 3.4% (95% CI, 2.8% - 5.2%), with eight (0.9%) IgM positive and 22 (2.4%) IgG positive. Accordingly, 9075 (95% CI, 6586 - 14,170) people are estimated to have had a current or recent COVID-19 infection, symptomatic or asymptomatic. <strong>Conclusion and Recommendations:</strong> Serological testing as a diagnostic or surveillance tool may uncover a large proportion of asymptomatic individuals in the community, far outnumbering PCR. The authors highly recommend further precautionary public measures, as well as an ongoing surveillance programme to monitor the epidemiological trends of the disease in the city of Misrata and Libya in general.
文摘Introduction and Objectives: Since its advent in 2019, Corona Virus Disease 19 (Covid-19) has changed everyday life in many unprecedented ways. With the availability of Covid-19 vaccines, clinical practice has stepped gradually towards its everyday routine. The clinician, however, needs to address such concerns as “Can Covid-19 present with urinary tract symptoms predominantly?”, “Can the urinary tract develop long-term Covid-19 symptoms?”, “Can Covid-19 vaccines/drug therapy cause male infertility?” Methods: This mini-review of the current literature has been carried out by searching the Pubmed database. Results and Conclusions: Our literature review suggests that there is insufficient evidence to conclude a significant impact on the urinary tract from Covid-19 infection. There is supporting evidence that mRNA anti-SARS-CoV-2 vaccines are safe for male gonads. Research to further support these conclusions is required.
