Immune Senescence Markers Predict the Cellular Immune Response to BNT162b2 Vaccination in Hemodialysis Patients.

Background: Chronic kidney disease is associated with increased risk of frailty and accelerated immune senescence, potentially affecting the immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. Methods: Humoral and cellular responses against the spike protein of SARS-CoV-2 were determined in 189 COVID-naive hemodialysis patients at week 4 and 8 after vaccination with 2 doses of BNT162b2. Frailty indicators and immune senescence markers were determined at baseline to identify predictors of the immune response. Results: Controlling for age, activities of daily living (ADLs), instrumental ADLs, walking pace, and the clinical frailty score correlated negatively and hand grip strength positively with the humoral response. Controlling for age, the proportions of memory CD4+ T cells, memory CD8+ T cells, CD28null T cells, and CD57+CD8+ T cells correlated negatively with the humoral response, whereas the proportions of memory CD4+ T cells and CD28null T cells correlated negatively and the CD4/CD8 ratio positively with the cellular response. In a multivariate model, only the proportions of memory CD4+ T cells and CD28null T cells independently predicted the cellular response. Conclusions: Markers of immune senescence, but not frailty indicators, independently predict the cellular immune response after vaccination in hemodialysis patients, overruling the effect of chronological age.

Aerosol suppression from a handpiece using viscoelastic solution in confined dental office

Aerosolized droplets are produced en masse in dental practices;these aerosols disperse in the surrounding space, posing a health threat if the patient is infected with a transmittable disease, particularly COVID-19. Here, a viscoelastic polyacrylic acid (PAA) solution was used to minimize liquid aerosolization and limit the travel distance of aerosols. The PAA concentration was varied to evaluate its effect on aerosolization and droplet size resulting from procedures using dental handpieces, which include tooth cutting, grinding, and polishing. In addition, a thermocouple was inserted at the center of the model tooth to measure its temperature during a handpiece operation. The temperature data suggest that the cooling performance of the PAA solution is comparable to that of pure water in operations in the occlusal and facial directions. The PAA solution droplets splattered on the patient's facial area during the handpiece operation are markedly larger than those of pure water, which is evidence of the settling of the PAA droplets, preventing further transmission. Accordingly, the travel distance of the aerosolized PAA droplets was limited by viscoelastic resistance to droplet detachment. This comparison of the aerosol suppression capability between water and PAA solutions confirms the benefit of using viscoelastic solutions for various dental operations. Published under an exclusive license by AIP Publishing.

[Guillain-Barre syndrome associated with COVID-19]. / Sindrom Giiena­Barre, assotsiirovannyi s COVID-19.

This paper reports two cases of Guillain-Barre syndrome associated with coronavirus infection COVID-19. The clinical symptoms and neurological status of patients, the data of the additional examination and the features of the prescribed therapy are described in detail. The issue of the tropicity of the SARS-CoV-2 virus to human nervous tissue and its possible ways of affecting the peripheral nervous system is discussed.

Myocarditis After COVID-19 Vaccination: A Systematic Review of Case Studies

Background: The coronavirus disease of 2019 (COVID-19) is a global pandemic with over 200 million cases and four million deaths worldwide. Anti-COVID-19 vaccinations have had exceptional success in subduing the incidence, prevalence, and disease severity of COVID-19, but rare cases of myocarditis have been reported after COVID-19 vaccinations. Methods: We performed a systematic literature search on PUBMED, MEDLINE, EMBASE, and Cochrane Reviews database from inception to July 18, 2021. Studies were analyzed based on predetermined eligibility criteria. Results: A total of 19 studies containing 73 cases of COVID-19 vaccine-associated myocarditis were catalogued. Mean age was 25 years, and male to female ratio was 17:1. For 87.7% of patients, myocarditis occurred after the second dose. Average time to onset and length of hospitalization were 3.5 days and 5.2 days, respectively. Prognosis was benign with 100% recovery. Chest pain (100%);elevation of troponin (100%) and CRP (94.4%);and ST elevation on EKG (81.4%) were common. NSAIDs (73.5%) were the most used medication, followed by colchicine (50%). Conclusions: Patients with COVID-19 vaccine-associated myocarditis are usually younger males presenting with chest pain 3.5 days after receiving their second dose. Work-up typically shows elevation of troponin and CRP with ST changes in EKG. Diagnosis is made after excluding all other etiologies. Given significant population benefit from COVID-19 vaccination, physicians should continue to encourage vaccination while remaining vigilant of the very rare occurrence of myocarditis following COVID-19 vaccination. [Formula presented]

COVID-19 in dialysis: clinical impact, immune response, prevention, and treatment.

The COVID-19 pandemic has profound adverse effects on the population on dialysis. Patients requiring dialysis are at an increased risk of SARS-CoV-2 infection and mortality, and many have experienced psychological distress as well as delayed or suboptimal care. COVID-19 survivors have prolonged viral shedding, but generally develop a robust and long-lasting humoral immune response that correlates with initial disease severity. However, protection against reinfection is incomplete. A growing body of evidence reveals delayed and blunted immune responses to SARS-CoV-2 vaccination. Administration of a third dose within 1 to 2 months of prime-boost vaccination significantly increases antibody levels, in particular in patients with poor initial responses. Patients on dialysis have inferior immune responses to adenoviral vector vaccines than to mRNA vaccines. The immunogenicity of the mRNA-1273 vaccine is markedly better than that of the BNT162b2 vaccine, most likely by virtue of its higher mRNA content. Despite suboptimal immune responses in patients on dialysis, preliminary data suggest that vaccination partially protects against infection and severe disease requiring hospitalization. However, progressive waning of immunity and emergence of SARS-CoV-2 variants with a high potential of immune escape call for a booster dose in all patients on dialysis 4 to 6 months after prime-boost vaccination. Patients with persistent poor vaccine responses may be candidates for primary prophylaxis strategies. In the absence of specific data in patients on dialysis, therapeutic strategies in the event of established COVID-19 must be extrapolated from evidence obtained in the population not on dialysis. Neutralizing monoclonal antibodies may be an attractive option after a high-risk exposure or during the early course of infection.

A SSA-Based Attention-BiLSTM Model for COVID-19 Prediction

The Corona Virus Disease 2019 (COVID-19) has widely spread over the world and comes up with new challenges to the research community. Accurately predicting the number of new infections is essential for optimizing available resources and slowing the progression of such diseases. Long short-term memory network (LSTM) is a typical method for COVID-19 prediction in deep learning, but it is difficult to extract potentially important features in time series effectively. Thus, we proposed a Bidirectional LSTM (BiLSTM) model based on the attention mechanism (ATT) and used the Sparrow Search Algorithm (SSA) for parameter tuning, to predict the daily new cases of COVID-19. We capture the information in the past and future through the BiLSTM network and apply the attention mechanism to assign different weights to the hidden state of BiLSTM, enhance the ability of the model to learn vital information, and use the SSA to optimize the critical parameters of the model for matching the characteristics of COVID-19 data, enhance the interpretability of the model parameters. This study is based on daily confirmed cases collected from six countries: Egypt, Ireland, Iran, Japan, Russia, and the UK. The experimental results show that our proposed model has the best predictive performance among all the comparison models. © 2021, Springer Nature Switzerland AG.

Dynamics of the Cellular and Humoral Immune Response After BNT162b2 Messenger Ribonucleic Acid Coronavirus Disease 2019 (COVID-19) Vaccination in COVID-19-Naive Nursing Home Residents.

Short-term humoral and cellular immune responses are diminished after BNT162b2 messenger ribonucleic acid coronavirus disease 2019 (COVID-19) vaccination in COVID-19-naive nursing home residents, a population particularly vulnerable to the disease. We found both responses to decline after 4 weeks and remain lower than those of healthcare workers after 24 weeks, with an estimated half-life of the antibody response of 47 days. At 4 weeks, older age was significantly associated with a decreased humoral response, and diabetes mellitus and active malignancy were associated with a decreased cellular response. Our results imply that COVID-19-naive nursing home residents are a target group for booster vaccination trials.

Predictors and Dynamics of the Humoral and Cellular Immune Response to SARS-CoV-2 mRNA Vaccines in Hemodialysis Patients: A Multicenter Observational Study.

BACKGROUND: Preliminary evidence suggests patients on hemodialysis have a blunted early serological response to SARS-CoV-2 vaccination. Optimizing the vaccination strategy in this population requires a thorough understanding of predictors and dynamics of humoral and cellular immune responses to different SARS-CoV-2 vaccines. METHODS: This prospective multicenter study of 543 patients on hemodialysis and 75 healthy volunteers evaluated the immune responses at 4 or 5 weeks and 8 or 9 weeks after administration of the BNT162b2 or mRNA-1273 vaccine, respectively. We assessed anti-SARS-CoV-2 spike antibodies and T cell responses by IFN-γ secretion of peripheral blood lymphocytes upon SARS-CoV-2 glycoprotein stimulation (QuantiFERON assay) and evaluated potential predictors of the responses. RESULTS: Compared with healthy volunteers, patients on hemodialysis had an incomplete, delayed humoral immune response and a blunted cellular immune response. Geometric mean antibody titers at both time points were significantly greater in patients vaccinated with mRNA-1273 versus BNT162b2, and a larger proportion of them achieved the threshold of 4160 AU/ml, corresponding with high neutralizing antibody titers in vitro (53.6% versus 31.8% at 8 or 9 weeks, P<0.0001). Patients vaccinated with mRNA-1273 versus BNT162b2 exhibited significantly greater median QuantiFERON responses at both time points, and a larger proportion achieved the threshold of 0.15 IU/ml (64.4% versus 46.9% at 8 or 9 weeks, P<0.0001). Multivariate analysis identified COVID-19 experience, vaccine type, use of immunosuppressive drugs, serum albumin, lymphocyte count, hepatitis B vaccine nonresponder status, and dialysis vintage as independent predictors of the humoral and cellular responses. CONCLUSIONS: The mRNA-1273 vaccine's greater immunogenicity may be related to its higher mRNA dose. This suggests a high-dose vaccine might improve the impaired immune response to SARS-CoV-2 vaccination in patients on hemodialysis.

Multistep Forecasting of New COVID-19 Cases Based on LSTMs Using Bayesian Optimization

The multistep prediction of new Corona Virus Disease (COVID-19) cases plays a vital role during the epidemic control period, and the Long Short-Term Memory (LSTM) based time series analysis model is the most frequently used among many prediction methods. But whether it is the cumulative error of the multistep prediction or the instability of the new case data of the COVID-19 make the performance of LSTM in this task not so good. In this paper, we selected three countries with more severe COVID-19 epidemics-India, Russia, and Chile, to predict new cases in the next 15 days with different multistep LSTM network models, and use Bayesian Optimization to explore the optimal hyperparameter space. The results show that: a) the performance of Recursive Prediction LSTM is the best (Mean Absolute Percentage Error, MAPE was reduced to 14.88%, 6.46%, and 16.31% for the three countries respectively), Encoder Decoder LSTM is second (15.52%, 19.61%, 19.87%), and the effect of vector output LSTM is the worst (23.55%, 26.82%, 19.57%);b) there are obvious extremely poor areas in the hyperparameter space, and the Bayesian Optimizer can focus on the good areas to avoid cost of tuning parameters based on bad hyperparameters;c) the data of new cases of COVID-19 in different countries have great differences in the hyperparameter expectations for the model. The bad area of hyperparameters and different expectations are likely to be one of the reasons why the COVID-19 data of different countries is hard to train jointly. © 2021 ACM.

An Improved SEIR Model for Reconstructing the Dynamic Transmission of COVID-19

With the recent outbreak of coronavirus disease 2019 (COVID-19), human life and the world economy have been severely affected, the propagation and scale of COVID-19 is top of mind for everyone. To reconstruct the development trend of COVID-19, we investigate the issue of the epidemic spreading process under vigorous non-pharmaceutical interventions. Here, an improved Susceptible-Exposed-Infectious-Recovered (SEIR) model with dynamic variables (i.e., health exposure individuals and close contacts) is proposed to predict the scale of COVID-19 and its dynamic evolution. We assume that the number of contacts and the reproduction number of COVID-19 changes dynamically over time. Then a gradient descent method is applied to estimate the effective reproduction number. We use the proposed model to reconstruct the dynamic transmission of COVID-19 in Chongqing between 14 January and 24 March 2020. The results show a similar development trend with a real-world epidemic. Our work has important implications when considering strategies for continuing surveillance and interventions to eventually contain outbreaks of COVID-19.

Changes in undergraduate medical education due to COVID-19: a systematic review.

OBJECTIVE: This study aims to provide medical educators with insights into the current status and prospects of undergraduate medical education, which has been affected by the COVID-19 pandemic. MATERIALS AND METHODS: We conducted a database search of PubMed, Embase, and ERIC and identified articles on COVID-19-related undergraduate medical education. We independently reviewed titles and abstracts and extracted data on the geographic location of the study, area of specialty, phase in medical school (preclinical year, clerkship year, etc.), type of paper, and the main content of the study. RESULTS: A total of 49 articles published across multiple countries were included in this study. These were categorized as dealing with either (1) curriculum changes in undergraduate medical education due to COVID-19 or (2) student-led educational activities related to COVID-19. The 41 articles in the first category showed two main trends: replacing in-person lectures with online classes in the preclinical years and adopting various remote educational methods to compensate for the discontinued or truncated clerkship in the clinical years. The eight articles in the second category showcased various student educational activities that were conducted to meet the public's medical needs during the pandemic. CONCLUSIONS: This review summarized the essential changes in undergraduate medical education worldwide and reflected on the various teaching methods adopted by medical schools. In preparation for the post-COVID era, a comprehensive online curriculum and evaluation tools are needed, which require the development of necessary infrastructure and adequate resources. Education aimed at helping students be more socially aware and responsible as medical professionals must be promoted.

Incidence, Characteristics, and Outcome of COVID-19 in Adults on Kidney Replacement Therapy: A Regionwide Registry Study.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection disproportionally affects frail, elderly patients and those with multiple chronic comorbidities. Whether patients on RRT have an additional risk because of their specific exposure and complex immune dysregulation is controversial. METHODS: To describe the incidence, characteristics, and outcomes of SARS-CoV-2 infection, we conducted a prospective, multicenter, region-wide registry study in adult patients on RRT versus the general population from March 2 to May 25, 2020. This study comprised all patients undergoing RRT in the Flanders region of Belgium, a country that has been severely affected by coronavirus disease 2019 (COVID-19). RESULTS: At the end of the epidemic wave, crude and age-standardized cumulative incidence rates of SARS-CoV-2 infection were 5.3% versus 2.5%, respectively, among 4297 patients on hemodialysis, and 1.4% versus 1.6%, respectively, among 3293 patients with kidney transplants (compared with 0.6% in the general population). Crude and age-standardized cumulative mortality rates were 29.6% versus 19.9%, respectively, among patients on hemodialysis, and 14.0% versus 23.0%, respectively, among patients with transplants (compared with 15.3% in the general population). We found no excess mortality in the hemodialysis population when compared with mean mortality rates during the same 12-week period in 2015-2019 because COVID-19 mortality was balanced by lower than expected mortality among uninfected patients. Only 0.18% of the kidney transplant population died of SARS-CoV-2 infection. CONCLUSIONS: Mortality associated with SARS-CoV-2 infection is high in patients on RRT. Nevertheless, the epidemic's overall effect on the RRT population remained remarkably limited in Flanders. Calculation of excess mortality and age standardization provide a more reliable picture of the mortality burden of COVID-19 among patients on RRT.

Challenges in the Korean medical system after the end of the mers that hit Korea in 2015

Background/Objectives: Middle East Respiratory Syndrome(MERS) is caused by the MERS-Korona virus, a type of beta-corona virus, is a serious respiratory disease with numerous reported. The purpose of this study was to provide a comprehensive review of MERS in Korea in 2015 and use it as basic data for preventing future infectious diseases in Korea. Methods/Statistical analysis: This study was designed by the authority. The research material, after MERS-CoV's declaration of an end, the authorities searched the website of a reputable organization in Korea for a proven report on MERS-CoV. Findings: Of 111 male patients and 75 female patients with laboratory-confirmed MERS-CoV infections between May 20, and July 13, 2015, total 38(20.4% fatality rate) case died. The most common causes of infection occurred in hospital visits and hospital admissions. 82 (44.1%) patients;64(34.4%) were patients’ family, caregivers, or visitors;39(21.0%) were healthcare personnel, and one(0.5%) case was of unknown origin. It was associated with 16 medical institutions, most of them related to medical institutions. Improvements/Applications: Judging by this nature, isolation in the hospital of the initial and estimated superconductors is paramount and is an important criterion for prevention and isolation in the future 'Management and Countermeasures of Infectious Diseases'. © 2020, Hampstead Psychological Associates. All rights reserved.

Environmental contamination in the isolation rooms of COVID-19 patients with severe pneumonia requiring mechanical ventilation or high-flow oxygen therapy.

BACKGROUND: Identifying the extent of environmental contamination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is essential for infection control and prevention. The extent of environmental contamination has not been fully investigated in the context of severe coronavirus disease (COVID-19) patients. AIM: To investigate environmental SARS-CoV-2 contamination in the isolation rooms of severe COVID-19 patients requiring mechanical ventilation or high-flow oxygen therapy. METHODS: Environmental swab samples and air samples were collected from the isolation rooms of three COVID-19 patients with severe pneumonia. Patients 1 and 2 received mechanical ventilation with a closed suction system, while patient 3 received high-flow oxygen therapy and non-invasive ventilation. Real-time reverse transcription-polymerase chain reaction (rRT-PCR) was used to detect SARS-CoV-2; viral cultures were performed for samples not negative on rRT-PCR. FINDINGS: Of the 48 swab samples collected in the rooms of patients 1 and 2, only samples from the outside surfaces of the endotracheal tubes tested positive for SARS-CoV-2 by rRT-PCR. However, in patient 3's room, 13 of the 28 environmental samples (fomites, fixed structures, and ventilation exit on the ceiling) showed positive results. Air samples were negative for SARS-CoV-2. Viable viruses were identified on the surface of the endotracheal tube of patient 1 and seven sites in patient 3's room. CONCLUSION: Environmental contamination of SARS-CoV-2 may be a route of viral transmission. However, it might be minimized when patients receive mechanical ventilation with a closed suction system. These findings can provide evidence for guidelines for the safe use of personal protective equipment.