Long-term outcomes for epidemic viral pneumonia survivors after discharge from the intensive care unit: a systematic review

ABSTRACT Objective To review the long-term outcomes (functional status and psychological sequelae) of survivors of critical illnesses due to epidemic viral pneumonia before the COVID-19 pandemic and to establish a benchmark for comparison of the COVID-19 long-term outcomes. Methods This systematic review of clinical studies reported the long-term outcomes in adults admitted to intensive care units who were diagnosed with viral epidemic pneumonia. An electronic search was performed using databases: MEDLINE®, Web of Science™, LILACS/IBECS, and EMBASE. Additionally, complementary searches were conducted on the reference lists of eligible studies. The quality of the studies was assessed using the Newcastle-Ottawa Scale. The results were grouped into tables and textual descriptions. Results The final analysis included 15 studies from a total of 243 studies. This review included 771 patients with Influenza A, Middle East Respiratory Syndrome, and Severe Acute Respiratory Syndrome. It analyzed the quality of life, functionality, lung function, mortality, rate of return to work, rehospitalization, and psychiatric symptoms. The follow-up periods ranged from 1 to 144 months. We found that the quality of life, functional capacity, and pulmonary function were below expected standards. Conclusion This review revealed great heterogeneity between studies attributed to different scales, follow-up time points, and methodologies. However, this systematic review identified negative long-term effects on patient outcomes. Given the possibility of future pandemics, it is essential to identify the long-term effects of viral pneumonia outbreaks. This review was not funded. Prospero database registration: (www.crd.york.ac.uk/prospero) under registration ID CRD42021190296.

Knowledge and Attitude of Adult Saudi Community towards Premarital Screening Program (Sickle Cell Anemia/Thalassemia) in Riyadh Province of Saudi Arabia

Background: Premarital Screening (PMS) program in Saudi Arabia aims at limiting the spread of hereditary diseases like Sickle Cell Anemia (SCA) and Thalassemia and infectious diseases like Hepatitis B&C and Human immunodeficiency virus (HIV). Although the PMS program is reducing the percentage of incompatible marriages, the prevalence of hemoglobinopathies is still remaining high. With the changing perception of the general population towards the PMS program, an examination of community awareness and attitude toward PM S is needed to find ways for reducing the prevalence of diseases. Objective : T o assess the present knowledge and attitude of the adult Saudi community from Riyadh Province to the premarital screening (PMS) program for hemoglobinopathies. Methods: This cros s - sectional study was conducted on 676 participants from the general population in June - September 2022. The electronic questionnaire was used to assess the sociodemographic data, knowledge, and attitude toward the PMS program. Results: Out of the 676 participants, 58% were females, and 42% were males. 54% had consanguineous marriages and 5.6% hemoglobinopathies in the family. 96.3% agreed on suggesting PMS to others, 83.2% considered PMS incompatible marriage is wrong, and 78.6% considered associated g enetic counselling is important. 22.7% preferred consanguineous marriage over non - consanguineous. For raising awareness, 97.6%, 85.9%, 84.6%, and 81.2% of respondents felt the need for community participation through the internet, social media, and medical education in schools respectively. Conclusion: Most participants have a positive attitude but only superficial knowledge of the PMS program and one - third are still unaware of its use for the prevention of hemoglobinopathies, especially thalassemia. Increa sing the knowledge about the importance of the PMS program and associated genetic counselling should be done with multiple information sources in a well - organized way that suits the community’s requirements.

REVIEW ON STRUCTURE, PATHOGENECITY, TRANSMISSIBILITY AND EPIDEMIOLOGY OF HUMAN PATHOGENIC CORONAVIRUSES

Coronaviruses cause animal and human respiratory and bowel infections. They have not been deemed highly pathogenic to humans until the outbreak of severe acute respiratory syndrome (SARS) in 2002 and 2003 in Guangdong province, China. Coronaviruses (CoVs) are large, enveloped, positive-sense, single-stranded RNA viruses that can infect both animals and humans. Coronaviruses didn't just appear recently. They are large family of viruses that have been around for a long time. Formerly, coronaviruses (CoVs) were seen as relatively harmless respiratory pathogens to humans. However, two outbreaks of severe respiratory tract infection, caused by the severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV) caused high pathogenicity and mortality rates among human populations as a result of zoonotic CoVs crossing the species barrier. Now the recent detection of the 2019 novel coronavirus (COVID-19), added a new member in corona virus family.The novel coronavirus (COVID 19) is one of the member of coronavirus family which infect human. Scientists have divided coronaviruses into four sub- groupings, called alpha, beta, gamma and delta. Seven of these viruses can infect people. The four common coronaviruses are-229E(alpha), NL63(alpha), OC43(beta), HKU1(beta). The three less-common coronaviruses are- MERS-CoV(beta), SARS-CoV(beta), SARS-CoV-2. Our main target is to describe the the structure, Pathogenecity, Transmissibility and Epidemiology of above mentioned subgroups of corona viruses in our review

Overview of SARS-CoV-2 and COVID-19 pandemic

ABSTRACT@#Coronavirus disease 2019 (COVID-19) which caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV2) is the prevailing global health issue at this time, spreading rapidly despite various containment efforts. It is first reported in Wuhan, China in December 2019 and the total number of cases has reached 7,064,230 with 404,585 total deaths globally to date (June 7, 2020). SARS-CoV-2 is reported closely related to SARS-CoV and MERS-CoV, the virus causes only mild symptoms in the majority of cases. However, it can progress to pneumonia and acute respiratory distress syndrome (ARDS), eventually leading to multiple organ dysfunction, the major cause of mortality among affected patients. The primary modes of transmission include droplet and contact infection, and possibly respiratory aerosols in settings where aerosol-generating procedures (AGPs) occur. Diagnosis mainly relies on detecting the viral RNA in nasopharyngeal and oropharyngeal specimens, combined with imaging techniques such as chest X-ray and computerized tomography (CT) scan. Currently, no empirical therapy or vaccine is available yet for the virus, and supportive measures remain the mainstay of treatment. Information about the virus is being updated every day. This review article summarizes the current knowledge surrounding the outbreak, including epidemiology, virological facts, pathogenesis, clinical findings, diagnostic criteria, and currently available therapeutics and vaccines, with a special emphasis on Middle Eastern countries including Saudi Arabia.

Review and Prospects of Pathogen Detection Related to Autopsy of Coronavirus Infectious Diseases / 法医学杂志

In the past, coronavirus caused two serious human-to-human pandemics in the world, including severe acute respiratory syndrome （SARS） and Middle East respiratory syndrome （MERS）. In late 2019, coronavirus disease 2019 （COVID-19） caused another major global public health event. Due to the strong infectivity of novel coronavirus, it is difficult to carry out the autopsy of related death cases widely. This paper reviews the previous status of the pathogen detection related to the autopsy of coronavirus infection diseases, and introduces the ongoing detection methods of novel coronavirus in clinical practice, in order to provide reference for the pathogen detection and study related to autopsy of COVID-19.

Overview of the Management of COVID-19 Efficacy and Doubts

Coronavirus disease 2019 (COVID-19) is defined as an illness caused by a novel coronavirus now called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2. It was first identified during an outbreak of respiratory illness cases in Wuhan City, Hubei Province, China.Management of COVID-19 is still unspecific as there are no vaccine orspecific antiviral drugs areavailable for its treatment. This paper reviewsthemanagement efficacy and doubt of COVID-19.Methods: A comprehensive search from relevant literatures, World Health Organization (W.H.O), Centre for Disease Control and prevention (CDC) official websites and announcements was performed between 1 March2020 to 10:30 am 22 April 2020 (Nigerian time). A latest summary of 2019-nCoV and the current outbreak was drawn.Conclusion: The covid-19 pandemic is spreading rapidly and several researchers are making efforts to discover drugs for its treatment. Chloroquine phosphate, vaccines and other forms of management strategies have been employed. However, preventive measureslike social distancing, washing of handswith soap and water, wearing of face masks and psychosocial treatment should be adopted while waiting for pharmacological treatments.

COVID-19: The outbreak caused by a new coronavirus / COVID-19: la epidemia causada por un nuevo coronavirus

Abstract Before the severe acute respiratory syndrome outbreak in 2003, coronaviruses (CoVs) were not considered to be highly pathogenic to humans. However, it was this epidemic that highlighted this group of viruses and included them among the causative agents of emerging epidemic diseases. In addition, in 2012, another new CoV responsible for the Middle East respiratory syndrome was identified. Both infections were considered a threat to global health security. At present, the third epidemic caused by a CoV is being faced. This new CoV, called 2019-nCoV, was originated in the city of Wuhan, China, and has been linked to severe respiratory infections in humans. Thanks to the collaboration of experts worldwide, more information about this virus and its infection is reported each day, which allows modifying the recommendations for its prevention and treatment, without forgetting that the ultimate goal is to control this epidemic. In this review, the important aspects of this new coronavirus, 2019-nCoV, and its disease, COVID-19, have been summarized with the information available up to February 2020.

Resumen Previo al brote del síndrome respiratorio agudo grave de 2003, los coronavirus (CoV) no eran considerados como agentes altamente patogénicos para los humanos. Sin embargo, fue dicha epidemia la que destacó este grupo de virus y lo incluyó entre los agentes causantes de enfermedades epidémicas emergentes. Adicionalmente, en 2012 se identificó un nuevo CoV causante del síndrome respiratorio de Oriente Medio. Ambas infecciones fueron consideradas una amenaza para la seguridad sanitaria mundial. Hoy en día se presenta la tercera epidemia causada por un CoV. Este nuevo CoV, llamado 2019-nCoV, se originó en la ciudad de Wuhan, China, y ha sido relacionado con infecciones respiratorias graves en humanos. Gracias a la colaboración de expertos en todo el mundo, cada día se logra obtener más información sobre este virus y la infección que causa, lo cual permite modificar las recomendaciones para su prevención y tratamiento sin olvidar que el fin último es lograr el control de la epidemia. En esta revisión se resumen los aspectos más importantes acerca del nuevo 2019-nCoV y la enfermedad COVID-19, con la información disponible hasta febrero de 2020.

Bat-related coronavirus / 第二军医大学学报

The outbreak of coronavirus disease 2019 (COVID-19) in Dec. 2019 sounded another alarm for humanbeing, with the first being the outbreak of severe acute respiratory syndrome (SARS) in 2003. Researchers found that the natural host of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the pathogen of COVID-19, may be the Rhinolophus sinicus. There have been four outbreaks of coronaviruses (severe acute respiratory syndrome coronavirus [SARS-CoV], Middle East respiratory syndrome coronavirus [MERS-CoV], swine acute diarrhea syndrome coronavirus [SADS-CoV] and SARS-CoV-2) worldwide since the beginning of 21st century, and they have caused huge threats and losses to human health, public health, economic development, and social stability. A large amount of evidence suggests that the natural host of all these four coronaviruses may be bats. This article reviews the species and global geographic distribution of bat-related coronaviruses, and the above-metioned four coronaviruses causing severe outbreaks.

Research progress on human coronavirus and antiviral drugs / 解放军医学杂志

Coronavirus mainly causes local infection in birds and mammals. In recent decades, there has been an evidence that it can infect humans. Highly pathogenic coronavirus, including severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), are fatal zoonotic viruses, which have posed a major threat to public health. Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2, COVID-19) has also seriously endangered the health and safety of the human beings. These coronaviruses transmit through close contact between people, resulting in the development of acute respiratory distress syndrome (ARDS) and multiple organ failure (MOF) and having a higher morbidity and mortality. This article reviews the structure, epidemiology, immunology and treatment of the coronavirus, hoping to provide reference for the prevention, control and treatment of the disease.

Diagnosis, treatment, control and prevention of SARS-CoV-2 and coronavirus disease 2019: back to the future / 生物工程学报

The ongoing outbreak of the coronavirus disease 2019 (COVID-19) as named by the World Health Organization has millions of confirmed cases around the world and has claimed hundreds of thousands of lives. The virus was named SARS-CoV-2 in February by International Committee on Taxonomy of Viruses. COVID-19 presents as fever, dry cough, dyspnea, headache and pneumonia. In a small subset of severe cases, the disease quickly progresses to respiratory failure and even death. Since the 21st century, there have been three major outbreaks caused by human coronaviruses, including the severe acute respiratory syndrome (SARS) that broke out in 2003, the Middle East respiratory syndrome (MERS) in 2012, and the recent pandemic of COVID-19. Since 2003, significant progress has been made in the study of SARS-CoV and MERS-CoV concerning their natural origins, pathogenesis, antiviral development and vaccine design. Since SARS-CoV-2 and SARS-CoV are closely related, previous findings on SARS-CoV are highly relevant to a better understanding as well as diagnosis, treatment, prevention and control of SARS-CoV-2. In this review, we highlight recent progresses in the field; compare the biological characteristics of SARS-CoV and SARS-CoV-2; summarize the urgently-needed diagnostic, treatment, prevention and control options; and provide future perspectives for the outcome of the outbreak and research questions to be answered, including some of the difficulties in vaccine development. Hopefully, our comments and suggestions would prove useful for the control of the SARS-CoV-2 epidemic in China and the world.

Review and Prospect of Pathological Features of Corona Virus Disease / 法医学杂志

Since 2003, coronavirus has caused multiple major public health events that resulted in global epidemics, such as severe acute respiratory syndrome （SARS）, Middle East respiratory syndrome （MERS） and corona virus disease 2019 （COVID-19）. Especially since COVID-19 outbroke in Wuhan, Hubei, in December 2019, coronavirus has had a significant impact on people's health and lives. But so far, the pathological diagnosis of COVID-19 has been relatively deficient： it is still confined to the pathological findings of punctured organs, and the majority of medical workers have poor awareness of its pathological characteristics. The COVID-19, as same as SARS and MERS, is caused by coronaviruses and can cause viral pneumonia. They have certain similarities. This article comprehensively reviews the pathological features observed in the autopsies of the aforementioned three diseases, in order to provide reference to the analysis of pathological changes of COVID-19.

Research progress of intervention of Chinese herbal medicine and its active components on human coronavirus / 中国中药杂志

The outbreak caused by 2019 novel coronavirus(2019-nCoV) is still spreading, posing a great threat to the safety and health of general population. However, there have not been any effective drugs for treatment, with symptomatic treatment and prevention prevailing. The treatment plans of severe acute respiratory syndrome(SARS) and Middle East respiratory syndrome(MERS) are often used for reference in clinic. The advantages of traditional Chinese medicine(TCM) in treating SARS and MERS are that it can intervene and block the progression of disease in early stage, significantly reduce symptoms, shorten the treatment duration of patients, reduce complications and side effects caused by hormone therapy. The coronavirus disease 2019(COVID-19) belongs to the category of TCM epidemic diseases. Chinese patent medicines and prescriptions in medical observation and clinical treatment were recommended in the "pneumonia diagnosis and treatment plan for new coronavirus infection"(trial version fifth) of the National Health Commission of the People's Republic of China. Qingfei Paidu Decotion was recommended for the treatment of COVID-19 by the National Health Commission of the People's Republic of China and National Administration of Traditional Chinese Medicine. TCM shows good clinical efficacy and great potential in the treatment of COVID-19. Previous studies of TCM have shown broad-spectrum antiviral activity, providing a variety of sources for the discovery of new antiviral drugs. In this paper, we reviewed traditional Chinese medicines and its active ingredients in the hope of bringing novel inspirations to the drug screening and clinical treatment for COVID-19.

Eficácia da máscara facial (TNT) na população para a prevenção de infecções por coronavírus: revisão sistemática / Effectiveness of the use of non-woven face mask to prevent coronavirus infections in the general population: a rapid systematic review

Resumo O objetivo deste artigo é avaliar a eficácia das máscaras faciais padrão tecido não tecido (TNT) para a prevenção de doenças respiratórias (MERS CoV, SARS-CoV e SARS-CoV-2) na população. Foi realizada busca nas bases de dados Medline, Embase, Cinahl, The Cochrane Library, Trip. Também busca complementar no Google Acadêmico, Rayyan e medRxiv. Não foram aplicados filtros relacionados a data, idioma ou status de publicação. Títulos e resumos foram rastreados e, posteriormente, textos completos foram avaliados. Foram incluídos três estudos: um ensaio clínico randomizado tipo cluster e duas revisões sistemáticas. O ensaio clínico indica benefício potencial de máscaras médicas para controle da fonte de infecção, para a doença respiratória clínica. Em uma das revisões sistemáticas, não foi possível estabelecer relação conclusiva entre uso da máscara e proteção contra infecção respiratória. Por fim, outra revisão sistemática demonstrou que máscaras são eficazes na prevenção da propagação de vírus respiratórios. As evidências apontam para benefício potencial das máscaras faciais padrão TNT. Para o cenário atual de pandemia por COVID 19, recomenda-se educação sobre uso adequado de máscaras, associado a medidas individuais de proteção.

Abstract Objectives: to evaluate the effectiveness of non-woven face masks for the prevention of respiratory infections (MERS CoV, SARS-CoV, and SARS-CoV-2) in the population. Methods: search in Medline, Embase, Cinahl, The Cochrane Library, Trip databases. Google Scholar, Rayyan and medRxiv were also consulted for complementary results. No filters related to date, language or publication status were applied. Titles and abstracts were screened, and later, full texts were evaluated. Results: three studies were included: a randomized cluster clinical trial and two systematic reviews. The clinical trial indicates a potential benefit of medical masks to control the source of clinical respiratory disease infection. In one of the systematic reviews, it was not possible to establish a conclusive relationship between the use of the mask and protection against respiratory infection. Finally, another systematic review indicated that masks are effective in preventing the spread of respiratory viruses. Conclusion: Evidence points to the potential benefit of standard non-woven face masks. For the current pandemic scenario of COVID-19, education on the appropriate use of masks associated with individual protection measures is recommended.

How Ophthalmologists Should Understand and Respond to the Current Epidemic of Novel Coronavirus Pneumonia (COVID-19) / 中华实验眼科杂志

The new coronavirus pneumonia that first appeared in Wuhan, China, in December 2019 has attracted great attention from both the Chinese government and the international community. The International Committee on Viral Classification named the virus "Severe Acute Respiratory Syndrome Coronavirus 2" (SARS-CoV-2), and the WHO named the pneumonia it causes "Coronavirus Disease 2019" (COVID-19). At present, the disease is centered in Wuhan City and is spreading rapidly to all parts of China, as well as twenty other countries. About 20% of the people infected during the SARS epidemic in 2003 were employees in hospital environments. COVID-19 has infected an even greater number of heath care workers. Therefore, ophthalmologists need to understand the disease and recognize the importance of taking preventive measures. Although ophthalmologists do not work on the front lines of the outbreak, due to their area of expertise, a variety of situations, such as infection consultations or ophthalmic emergency treatments, can lead to the exposure of ophthalmologists to high-risk environments. This risk will only increase as the number of infected patients continues to increase. When dealing with seemingly normal ophthalmic patients, the vigilance of ophthalmologists and associated staff tends to be significantly reduced. To better protect patients, families, and health care workers, it is strongly recommended that in addition to the standard precautions for the care of all patients, strict contact precautions and droplet precautions need to be taken by ophthalmologists. These measures include 1) wearing an efficient mask (an N95 mask); 2) always performing hand hygiene before and after examining a patient; (3) wearing sterile gloves when entering a patient’s room and touching a patient; (4) wearing a gown when contact is expected with items and environmental surfaces surrounding a patient or when the patient is incontinent or has diarrhea or a surgical or other invasive wound with oozing fluid; 5) cleaning and disinfecting ophthalmic equipment and correctly handling medical waste after examination to prevent transmission to patients who are subsequently examined; 6) wearing goggles and a disposable mask to cover the front and sides of the face before touching a patient, as the virus could spread through the ocular surface; 7) performing the relevant screening for novel coronavirus pneumonia for regular patients who have conjunctivitis and respiratory symptoms at the same time; 8) prohibiting the use of infected patients as potential donors for corneal transplants and temporarily adding donor SARS-CoV-2 screening to the medical standard of the eye bank during the outbreak; and 9) for the purposes of scientific research, diagnosis, and other special needs, packing, shipping, and transporting collected specimens according to the relevant dangerous biological goods regulations.

Use Stones from Another Mountain to Polish One’s Jade: Learn from MERS Studies toexplore potential mechanisms underlying the effect of diabetes mellitus on COVID-19 / 中华内分泌代谢杂志

Epidemiology studies suggest that comorbid diabetes may have negative impact on the progression and severity of the coronavirus disease 2019 (COVID-19), which first occurred in Wuhan. However, the exact mechanism remains unclear. A recent study on another type of coronavirus infection, Middle East Respiratory Syndrome (MERS), investigated its relationship with diabetes. This essay aims to give a brief introduction to this report and related studies, and to propose suggestions on what we can learn from these investigations to conduct further studies on the potential mechanisms underlying the effect of diabetes mellitus on COVID-19.

Vitamin D study: a retrospective comparison between two tropical countries: India and Bahrain

Background: Hypovitaminosis D is a very common prevalence in India as well as Middle East. Studies indicate the frequency to be anywhere between 44-96% among adults in Middle east, while in India it is estimated to range in between 50 – 94%. Our report is an attempt to study vitamin D status from two tropical countries; India and Bahrain and present status of vitamin D deficiency as well as insufficiency in a comparison summary.Methods: This retrospective study in our reference lab included data from a total of 2591 samples from Bahrain and 2596 samples from India. Serum vitamin D estimation was done by chemiluminescence immunoassay or CLIA and reported as per the classification given by the US Endocrine Society. Our reference laboratory provides diagnostic services to Bahrain and thus data from both the countries were available for analysis.Results: Our analysis detected vitamin D deficiency to be 66.2% among samples from India in comparison to 41.4% from Bahrain, and this difference was statistically significant at p<0.0001. Further, the average vitamin D levels in the cohort were detected to be higher in Bahrain samples at 24.0±11.6 ng/ml in comparison to samples from India at 18.2±14.4 ng/ml and statistically significant at p<0.0001.Conclusions: Many studies have documented the prevalence of hypovitaminosis D in a region-specific manner. Our report presents the picture of vitamin D status between two tropical countries to highlight the difference in vitamin D deficiency prevalence in two arid and semi-arid regions of the world.

Lipoid proteinosis in Middle East and North Africa: A case report and literature review

Lipoid proteinosis (LP) is a rare autosomal recessive genodermatosis characterized by the deposition of amorphous hyaline material in the skin, mucosa, and viscera. The classic manifestation is onset in infancy with a hoarse cry due to laryngeal infiltration. Skin and mucous membrane changes become apparent clinically, and the disease typically follows a slowly progressive, yet often benign, course. Virtually any organ may be involved, but visceral involvement rarely leads to clinically significant consequences. The aim of this study was to analyze the epidemiologic, genetic and clinical findings of reported cases in the Middle East and North Africa, reporting a case of LP to emphasize the occurrence of this condition in Saudi Arabia and to update information on latest development in diagnosis and management of LP. We review most of the cases reported in the Middle East and North Africa and analyze clinical signs and investigative findings, and we report a case with characteristic clinical and histological findings of LP. In the Middle East and North Africa, we found that the prevalence of LP is highest in Turkey with forty-eight reported cases. The reported cases in Saudi Arabia reached ten cases. In Iran, nine cases were reported, six of them belonging to two families. The fourth country in the prevalence of LP is Tunisia with five reported cases from the same family, followed by Kuwait with four reported cases. In our review of eightyone cases reported in the literature, we found variable incidence of mucocutaneous lesions that include multiple depressed acneiform scars on the face and extremities (96.29%, 78 cases), beaded eyelid papules (86.41%, 70 cases), thickening of the skin (51.85%, 42 cases), verrucous plaques on the knee and elbow (37.03%, 30 cases), involvement of the tongue (55.55%, 45 cases), and thickening of the frenulum (48.14%, 39 cases). Although LP has a benign course, it can be a cause of morbidity in these patients. Thus, a detailed examination to determine the extent of involvement is important from time to time. The pathogenesis of LP is still an enigma, and the rarity of these cases makes them worthy of reporting to facilitate a better understanding of the disease.

Psychiatric Morbidity of Survivors One Year after the Outbreak of Middle East Respiratory Syndrome in Korea, 2015 / 신경정신의학

OBJECTIVES: Patients with an infectious diseases during an outbreak can experience extreme fear and traumatic events in addition to suffering from their medical illness. This study examined the long-term impact of the outbreak of Middle East Respiratory Syndrome (MERS) in Korea, 2015 on the mental health of the survivors. METHODS: Sixty-three survivors from MERS were recruited from a prospective cohort study at six hospitals one year after the outbreak in 2015. The Korean-Symptom Check List 95 was administered to evaluate their psychiatric problems and analyzed according to the patient's characteristics and exposure to traumatic events during the outbreak. RESULTS: A total of 63.5% of survivors suffered from significant psychiatric problems: post-traumatic symptoms (36.5%), sleep problems (36.5%), anxiety (34.9%), and depression (30.2%). Survivors with a history of a ventilator treatment during the MERS epidemic, a family member who died from MERS, and a past psychiatric history showed higher post traumatic stress disorder, anxiety, depression, and suicidality than people who do not have those histories. CONCLUSION: The study suggests that MERS survivors could have a high chance of adverse psychiatric consequences, even after their recovery from MERS. Exposure to traumatic events during the outbreak and premorbid individual vulnerability would affect the long-term mental health problems.

Depression as a Mediator of Chronic Fatigue and Post-Traumatic Stress Symptoms in Middle East Respiratory Syndrome Survivors

OBJECTIVE: The relationship among chronic fatigue, depressive symptoms, and post-traumatic stress symptoms (PTSSs) among Middle East respiratory syndrome (MERS) survivors is poorly understood. METHODS: Of 148 survivors who consented to be registered and underwent assessments at 12 months (T1) and 18 months (T2) after the MERS outbreak, 72 (48.65%) were evaluated for chronic fatigue, depressive symptoms, and PTSSs based on the Impact of Event ScaleRevised (IES-R), the Patient Health Questionnaire-9 (PHQ-9), and the Fatigue Severity Scale (FSS). Data from 52 subjects, who completed both assessments, were analyzed using a regression-based serial multiple mediation model (PROCESS Model 6). RESULTS: Bootstrap analyses indicated no direct effects of T1 FSS on T2 IES-R but significant positive indirect effects of T1 FSS on T2 IESR through T1 PHQ-9 and T2 PHQ-9 (B=2.1601, SE=1.3268, 95% confidence interval=0.4250–6.1307). In other words, both T1 PHQ-9 and T2 PHQ-9 fully mediated the relationship between T1 FSS and T2 IES. CONCLUSION: Chronic fatigue 12 months after MERS had indirect effects on prolonged PTSSs 18 months after MERS via persisting depression in MERS survivors. This finding supports the need to promote interventional programs for emerging infectious disease survivors with chronic fatigue to reduce depression and prevent prolonged PTSSs.

Evolutionary relationship analysis of Middle East respiratory syndrome coronavirus 4a and 4b protein coding sequences

The 4a and 4b proteins of the Middle East respiratory syndrome coronavirus (MERS-CoV) have been described for their antagonism on host innate immunity. However, unlike clustering patterns of the complete gene sequences of human and camel MERS-CoVs, the 4a and 4b protein coding regions did not constitute species-specific phylogenetic groups. Moreover, given the estimated evolutionary rates of the complete, 4a, and 4b gene sequences, the 4a and 4b proteins might be less affected by species-specific innate immune pressures. These results suggest that the 4a and 4b proteins of MERS-CoV may function against host innate immunity in a manner independent of host species and/or evolutionary clustering patterns.