Single Nucleus RNA Sequencing of Remnant Kidney Biopsies and Urine Cell RNA Sequencing Reveal Cell Specific Markers of Covid-19 Acute Kidney Injury (preprint)

Acute kidney injury (AKI) in COVID-19 patients is associated with high mortality and morbidity. Critically ill COVID-19 patients are at twice the risk of in-hospital mortality compared to non-COVID AKI patients. We know little about the cell-specific mechanism in the kidney that contributes to worse clinical outcomes in these patients. New generation single cell technologies have the potential to provide insights into physiological states and molecular mechanisms in COVID-AKI. One of the key limitations is that these patients are severely ill posing significant risks in procuring additional biopsy tissue. We recently generated single nucleus RNA-sequencing data using COVID-AKI patient biopsy tissue as part of the human kidney atlas. Here we describe this approach in detail and report deeper comparative analysis of snRNAseq of 4 COVID-AKI, 4 reference, and 6 non-COVID-AKI biopsies. We also generated and analyzed urine transcriptomics data to find overlapping COVID-AKI-enriched genes and their corresponding cell types in the kidney from snRNA-seq data. We identified all major and minor cell types and states by using by using less than a few cubic millimeters of leftover tissue after pathological workup in our approach. Differential expression analysis of COVID-AKI biopsies showed pathways enriched in viral response, WNT signaling, kidney development, and cytokines in several nephron epithelial cells. COVID-AKI profiles showed a much higher proportion of altered TAL cells than non-COVID AKI and the reference samples. In addition to kidney injury and fibrosis markers indicating robust remodeling we found that, 17 genes overlap between urine cell COVID-AKI transcriptome and the snRNA-seq data from COVID-AKI biopsies. A key feature was that several of the distal nephron and collecting system cell types express these markers. Some of these markers have been previously observed in COVID-19 studies suggesting a common mechanism of injury and potentially the kidney as one of the sources of soluble factors with a potential role in disease progression. Translational StatementThe manuscript describes innovation, application and discovery that impact clinical care in kidney disease. First, the approach to maximize use of remnant frozen clinical biopsies to inform on clinically relevant molecular features can augment existing pathological workflow for any frozen tissue without much change in the protocol. Second, this approach is transformational in medical crises such as pandemics where mechanistic insights are needed to evaluate organ injury, targets for drug therapy and diagnostic and prognostic markers. Third, the cell type specific and soluble markers identified and validated can be used for diagnoses or prognoses in AKI due to different etiologies and in multiorgan injury.

First confirmed case of multisystem inflammatory syndrome in adult in Egypt.

Key Clinical Message: Our case report demonstrates extremely uncommon data associated with MIS-A, such as cholestatic jaundice, anemia, and quickly progressing pneumonia. IVIG and pulse steroid medications are the best treatments for improving clinical outcomes. Abstract: We report a case of multiple organ dysfunctions due to MIS-A in an adult with a history of suspected COVID-19. Our case demonstrates extremely uncommon data associated with MIS-A, such as cholestatic jaundice, anemia, and quickly progressing pneumonia. IVIG and pulse steroid medications are the best treatments for improving clinical outcomes.

Population-based sero-epidemiological investigation of SARS-CoV-2 infection in Somalia.

OBJECTIVES: To explore the burden of coronavirus disease 2019 (COVID-19) in Somalia by measuring the seroprevalence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the general population. METHODS: We recruited a convenience sample of 2751 participants from among individuals attending outpatient and inpatient departments of public health facilities, or their accompanying family members. Participants were interviewed to collect sociodemographic data and provided a blood sample. We calculated seropositivity rates overall and by sex, age group, state, residence, education and marital status. We used logistic regression analysis - odds ratios and 95% confidence intervals (CI) - to investigate sociodemographic correlates of seropositivity. RESULTS: The overall seropositivity rate was 56.4% (95% CI 54.5-58.3%), while 8.8% of participants reported being previously diagnosed with COVID-19 by July 2021. In the regression analysis, after controlling for covariates, urban residence was significantly asscoiated with seropositivity: OR = 1.74 (95% CI: 1.19-2.55). CONCLUSIONS: Our results show a high seroprevalence rate of SARS-CoV-2 in the Somali population (56.4%), and indicate that many infections have not been captured by the country's surveillance system resulting in considerable under-reporting.

Ligational behavior of bidentate nitrogen–oxygen donor 8‐quinolinolazodye toward Ni2+ and Zn2+ ions: Preparation, spectral, thermal, experimental, theoretical, and docking studies

The 5‐(4‐aryl azo)‐8‐hydroxyquinolines (L1–L3) and their metal complexes with Ni2+ and Zn2+ have been produced. Various spectroscopic techniques have been employed to analyze the ligand and complexes. The structures of the prepared compounds have been confirmed by Fourier transform infrared (FT‐IR), proton nuclear magnetic resonance (1H NMR), molar conductance, magnetic measurements, thermal gravimetric and differential thermal analyses (TG and DTA), and electronic transition. The FT‐IR spectra showed that the ligands are coordinated to the metal ions in a bidentate manner with donor sites of the azomethine‐N and phenolic‐OH. The FT‐IR and UV–Visible spectra were compared with the calculated results and showed a good agreement. The mass spectra concluded that the ligands' molecular weights and the calculated estimated m/z values match well. The complexes contain coordinated and hydrated water as confirmed by the TG results. The complexes are tetrahedral, trigonal bipyramid, and octahedral geometrical structures and act as non‐electrolytes in dimethylformamide (DMF) solvent. Using density functional theory (DFT) at the B3LYP level of theory and the 6‐311G** basis set for the C, H, N, Cl, and O atoms and the LANL2DZ basis set for the Ni and Zn atoms. Natural bond orbital (NBO) analysis was used to compute and describe the natural charge population and precise electronic configuration. The small energy gap between HOMO and LUMO energies suggests that charge transfer occurs within Ni2+ and Zn2+ complexes. The first‐order hyperpolarizability (β) of the complexes and the anisotropy of polarizability (α) values show promising optical properties. The electronic transitions of the prepared complexes were computed by time‐dependent density functional theory (TD‐DFT/PCM) with the B3LYP method using a 6‐31G** basis set. The ethanol polarizable continuum model (PCM) was used to simulate the solvent effect. Utilizing a computer virtual screening technique through molecular docking, the anticipation of binding of 8‐quinolinolazodye derivatives and their complexes with human CORONA virus protein (PDB ID: 5epw) was done. [ FROM AUTHOR] Copyright of Applied Organometallic Chemistry is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

The impact of COVID-19 on primary health care services in Qatar: 2 years of response and coping 2020-2021.

Background: Health care systems worldwide have rapidly responded to manage the COVID-19 pandemic by providing screening tests, contact tracing, treatment, and vaccination. However, the long duration of the pandemic has had an enormous load on the health care systems, which disrupted continuity of the essential non-covid services, long waiting time for appointments, and increase in the utilization of telemedicine services. Primary health care was established as an essential foundation for the global response to the COVID-19. In Qatar, Primary Heath Care Corporation (PHCC), the main primary care services provided played a major role in the response to the pandemic. However, its services were affected and disrupted, and new services were added. Hence, the aim of this analysis is to understand the long-term impact of the COVID-19 on the services provided by PHCC in Qatar in terms of PHCC pandemic response, change in utilization of the core, and preventative services, and the introduction of new alternative services. Methods: A retrospective data analysis was conducted for all the appointments and visits for all the PHCC health centers in the years of 2020 and 2021. The study conducted a comparison of the services utilizations using the utilization figures of PHCC services between 1st of January and 31st of December 2019 as a reference year. The differences in the utilization per service were presented in frequencies and percentages. Results: The in-person services dropped drastically in 2020 at 36% reduction in compassion to 2019. However, the newly introduced virtual consultation services in 2020 reached their highest utilization figures in 2021 at 908,965 virtual visits. The COVID-19 specific related services ranging from the COVID-19 drive-through testing to vaccine administration constituted a total number of 2,836,127 visits corresponding to 44% of the total PHCC services utilization visits in 2021. In 2021, PHCC dental services dropped by 25.2%. The most noticeable utilization drops in 2021 were among the preventative services with 53.2% and 78.9% in colorectal screening and non-communicable diseases (NCDs) risk factors annual screening services, respectively. However, mental health services have witnessed a surge in utilization at 134.1% increase in 2021 in comparison to 2019. Conclusion: The COVID-19 pandemic caused a disruption in the PHCC utilization of core services, namely dental services. Additionally, PHCC preventive services utilizations were affected drastically including cancer and NCDs risk factors annual screening. Nevertheless, PHCC managed to provide alternative virtual services and played a vital role in responding to the pandemic by leading the COVID-19 vaccination campaign in Qatar. However, future research is needed to establish which vulnerable patient groups were most affected by the pandemic, to continue to inform strategies and policies directed at mitigating the impact of future potential pandemics.

Development and validation of a predictive scoring system for in-hospital mortality in COVID-19 Egyptian patients: a retrospective study.

SARS-CoV-2 virus has rapidly spread worldwide since December 2019, causing COVID-19 disease. In-hospital mortality is a common indicator for evaluating treatment outcomes. Therefore, the developing and validating a simple score system from observational data could assist in modulating the management procedures. A retrospective cohort study included all data records of patients with positive PCR for SARS-CoV-2. The factors that associated with mortality were analyzed, then allocation of potential predictors of mortality was executed using different logistic regression modeling, subsequently scoring system was developed from the most weighted predictors. The mortality rate of patients with COVID-19 pneumonia was 28.5% and 28.74%, respectively. The most significant factors that affected in-hospital mortality were old age (> 60 years), delay in hospital admission (> 4 days), high neutrophil/lymphocyte ratio "NLR" (> 3); higher computed tomography severity score; and CT-SS (> 20), in addition to using remdesivir and tocilizumab in the treatment protocol (P < 0.001 for all). The validity of the newly performed score was significant; the AUC was 85%, P < 0.001, and its prognostic utility was good; the AUC was 75%, P < 0.001. The prognostic utility of newly developed score system (EGY.Score) was excellent and could be used to adjust the treatment strategy of highly at-risk patients with COVID-19 pneumonia.

Prevalence and epidemiological trends in mortality due to COVID-19 in Saudi Arabia.

OBJECTIVES: This article describes the prevalence and epidemiological trends of COVID-19 mortality in the largest registry in the Kingdom of Saudi Arabia (KSA). STUDY DESIGN: A prospective epidemiological cohort study using data from all healthcare facilities in KSA collected between March 23, 2020, and April 30, 2022. Data on the number of daily deaths directly related to COVID-19 were gathered, analyzed, and reported. METHOD: Data analysis was carried out using national and regional crude case fatality rate and death per 100,000 population. Descriptive statistics using numbers and proportions were used to describe age, gender, nationality, and comorbidities. The mortality trend was plotted and compared with international figures. In addition, the most common comorbidities associated with mortality and the proportion of patients who received COVID-19 vaccine were reported. RESULTS: The total reported number of deaths between March 23, 2020, and April 30, 2022, was 9085. Crude case fatality rate was 1.21%, and death per 100,000 population was 25.38, which compared favorably to figures reported by several developed countries. The highest percentages of deaths were among individuals aged between 60 and 69 years, males (71%), and individuals with diabetes (60%). Only 2.8% of mortalities occur in patients who received COVID-19 vaccine. Diabetes, hypertension, and heart failure had the highest attributable risk of mortality among patients who died due to COVID-19. CONCLUSION: Case fatality rate and death per 100,000 population in KSA are among the lowest in the world due to multiple factors. Several comorbidities have been identified, namely, diabetes, hypertension, obesity, and cardiac arrhythmias.

Covid-19 Vaccine Protection among Children and Adolescents in Qatar.

BACKGROUND: The BNT162b2 vaccine against coronavirus disease 2019 (Covid-19) has been authorized for use in children 5 to 11 years of age and adolescents 12 to 17 years of age but in different antigen doses. METHODS: We assessed the real-world effectiveness of the BNT162b2 vaccine against infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among children and adolescents in Qatar. To compare the incidence of SARS-CoV-2 infection in the national cohort of vaccinated participants with the incidence in the national cohort of unvaccinated participants, we conducted three matched, retrospective, target-trial, cohort studies - one assessing data obtained from children 5 to 11 years of age after the B.1.1.529 (omicron) variant became prevalent and two assessing data from adolescents 12 to 17 years of age before the emergence of the omicron variant (pre-omicron study) and after the omicron variant became prevalent. Associations were estimated with the use of Cox proportional-hazards regression models. RESULTS: Among children, the overall effectiveness of the 10-µg primary vaccine series against infection with the omicron variant was 25.7% (95% confidence interval [CI], 10.0 to 38.6). Effectiveness was highest (49.6%; 95% CI, 28.5 to 64.5) right after receipt of the second dose but waned rapidly thereafter and was negligible after 3 months. Effectiveness was 46.3% (95% CI, 21.5 to 63.3) among children 5 to 7 years of age and 16.6% (95% CI, -4.2 to 33.2) among those 8 to 11 years of age. Among adolescents, the overall effectiveness of the 30-µg primary vaccine series against infection with the omicron variant was 30.6% (95% CI, 26.9 to 34.1), but many adolescents had been vaccinated months earlier. Effectiveness waned over time since receipt of the second dose. Effectiveness was 35.6% (95% CI, 31.2 to 39.6) among adolescents 12 to 14 years of age and 20.9% (95% CI, 13.8 to 27.4) among those 15 to 17 years of age. In the pre-omicron study, the overall effectiveness of the 30-µg primary vaccine series against SARS-CoV-2 infection among adolescents was 87.6% (95% CI, 84.0 to 90.4) and waned relatively slowly after receipt of the second dose. CONCLUSIONS: Vaccination in children was associated with modest, rapidly waning protection against omicron infection. Vaccination in adolescents was associated with stronger, more durable protection, perhaps because of the larger antigen dose. (Funded by Weill Cornell Medicine-Qatar and others.).

Candidate Multi-Epitope Vaccine against Corona B.1.617 Lineage: In Silico Approach.

Various mutations have accumulated since the first genome sequence of SARS-CoV2 in 2020. Mutants of the virus carrying the D614G and P681R mutations in the spike protein are increasingly becoming dominant all over the world. The two mutations increase the viral infectivity and severity of the disease. This report describes an in silico design of SARS-CoV-2 multi-epitope carrying the spike D614G and P681R mutations. The designed vaccine harbors the D614G mutation that increases viral infectivity, fitness, and the P681R mutation that enhances the cleavage of S to S1 and S2 subunits. The designed multi-epitope vaccine showed an antigenic property with a value of 0.67 and the immunogenicity of the predicted vaccine was calculated and yielded 3.4. The vaccine construct is predicted to be non-allergenic, thermostable and has hydrophilic nature. The combination of the selected CTL and HTL epitopes in the vaccine resulted in 96.85% population coverage globally. Stable interactions of the vaccine with Toll-Like Receptor 4 were tested by docking studies. The multi-epitope vaccine can be a good candidate against highly infecting SARS-CoV-2 variants.

Dilemma of Treating Acute Myeloid Leukemia Patient After Kidney Transplant in the COVID-19 Era

Context: The incidence of malignancy increases after solid organ transplantation, which might be related to recipients' age and immunosuppressive drugs;this is accounted as the 3rd leading cause of death. Therefore, understanding cancer facts after transplantation is mandatory for transplant recipients' long-term care. Objective: A case study of a secondary acute myeloid leukemia (AML) patient after renal transplant complicated by COVID-19 infection. Design: A case report. Setting: Hematology Unit/Oncology Center, Mansoura University, Egypt. Patient: A 53-year-old male patient with a history of renal transplant due to end-stage renal failure since 2001. He was on steroids, cyclosporine (CSA), and mycophenolate mofetil since then. On December 31st, 2019, AML diagnosis (FAB-M4 AML) was confirmed by bone marrow aspiration (BMA), biopsy, and immunophenotyping (IPT). Cytogenetic and molecular analyses were negative for t(8;21), t(15;17), t(16;16), and FLT3 mutation. Interventions: He received induction chemotherapy with dose-adjusted 7+3, and immunosuppressant doses were reduced to steroids 10 mg and CSA 75 mg. BMA at D+28 showed complete remission (CR). The response was consolidated by 2 cycles of 5+2. On May 4th, 2020, CBC showed leukocytosis and anemia;BMA showed normocellular marrow with 5% blasts. Thus, he received 5 days of mitoxantrone with etoposide, and BMA reassessment was in CR. The patient's performance (PS) worsens after chemotherapy, so he continued subcutaneous cytarabine. On June 30th, 2020, the patient presented with fever and dyspnea. Relapse was confirmed by IPT and FLT-3 positivity. Chest high-resolution computed tomography (HRCT) showed bilateral mild pleural effusion and cardiomegaly. COVID-19 PCR was positive. Main Outcome Measures: The challenge was how to deal with relapse, COVID-19, and poor PS and kidney condition. He received dose-adjusted hydroxyurea with supportive measures, anticoagulant, and continued steroids. Results: Unfortunately, on August 4th, 2020, the patient was admitted to the ICU with disturbed consciousness and hyperleukocytosis with progression of HRCT and died. Conclusions: Our case had a unique presentation as the diagnosis of AML was very late after renal transplant. Managing the case was challenging as there is no consensus for this category of patients with the dilemma associated with their disease and the additional COVID-19 burden. Further studies are needed to validate a chemotherapy protocol for these patients.

Efficiency of Fe3O4@ZIF-8 for the removal of Doxorubicin from aqueous solutions: equilibrium, kinetics and thermodynamic studies.

Due to inadequate pharmaceutical wastewater treatment, anticancer contaminants from the pharmaceutical industry frequently end up in the aquatic environment where they endanger aquatic life and humans. As a result, the appropriate treatment of wastewater that contains anticancer agents is crucial for pollution prevention. The purpose of this work is to assess the effectiveness of a Fe3O4@ZIF-8 nanocomposite as an adsorbent to remove of the chemotherapeutic drugs doxorubicin (DOX) from aqueous solution. SEM, XRD, BET, FT-IR, Zeta potential, and point of zero charge analysis were used to study the surface and structural characteristics of the Fe3O4@ZIF-8 nanocomposite. Via the proposed treatment, 804.84 mg/g elimination was successful under the following circumstances: pH = 6; Fe3O4@ZIF-8 dose = 0.02 g/25 mL; DOX concentration = 1.22x10-3 mol; adsorption time = 100 min; and shaking speed = 200 rpm. A investigation of isotherms shown that the Langmuir equation and experimental data suited each other quite well. The adsorption of DOX on Fe3O4@ZIF-8 was endothermic and spontaneous, in accordance with thermodynamic properties. Furthermore, the elimination of DOX was enhanced by the rise in solution temperature. The kinetic analysis revealed that the pseudo-second order was fitted by the model. The suggested adsorption method could recycle Fe3O4@ZIF-8 nanocomposite six times, with a modest reduction in its ability for adsorption. For all XRD reflection peaks, physical characteristics including strain rates were computed and the dislocation of was 4.7 × 10-6. Investigate the activity of the DOX towards COVID-19, breast and prostate cancer using molecular docking.

ZnO-chlorogenic acid nanostructured complex inhibits Covid-19 pathogenesis and increases hydroxychloroquine efficacy.

Objective: The study purpose was to compare the anti- novel coronavirus disease 2019 (COVID-19) property of chlorogenic acid (CGA) and Zinc oxide nanoparticles (ZnO-NP) with the new valid synthesized complex of ZnO /CGA-NPs. Methods: The facile mixing method was utilized to prepare ZnO/CGA-NPs. The in vitro effect of different ZnO/CGA-NPs concentrations on papain-like protease (PLpro) and spike protein- receptor-binding domain (RBD) was measured by ELISA technique. The compounds effects on SARS-CoV2 were determined on viral entry, replication, and assembly by using plaque reduction assay, qPCR, and ELISA techniques. Their individual effects or mixed with hydroxychloroquine (HCQ) on erythrocytes (RBCs) and leukocytes (WBCs) were evaluated by routine cell culture technique. Finally, turbidity and agar well diffusion assays were done to evaluate their antimicrobial properties against Escherichia. coli, klebsila pneumonia, Streptococcus pyogenes, Staphylococcus aureus, and Candida albicans. Results: The results confirmed that the uniformly dispersed ZnO-NPs were converted to aggregated form of ZnO/CGA-NPs upon the addition of CGA. The inhibitory concentration 50 (IC50) of ZnO /CGA-NPs against RBD, angiotensin-converting enzyme 2 (ACE2) and PLpro were 1647.7, 323.3 µg/mL and 38.7 µg/mL, respectively. Also, it inhibited E-gene, RdRp gene, E-protein, and spike protein with an IC50 of 0.11, 0.13, 0.48, and 0.37 µg/mL, respectively. It acted as an antimicrobial against all tested organisms with a minimum inhibitory concentration (MIC) of 26 µg/mL. Finally, ZnO/CGA-NPs Complex (0.1 IC50) prevented the cytotoxic effect of HCQ on RBCs and WBC by 92.3 and 90 %, respectively. Conclusion: ZnO/CGA-NPs Complex can be considered as a new anti- severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) compound.

Evaluation of the Binding Relationship of the RdRp Enzyme to Novel Thiazole/Acid Hydrazone Hybrids Obtainable through Green Synthetic Procedure.

The viral RNA-dependent RNA polymerase (RdRp) complex is used by SARS-CoV-2 for genome replication and transcription, making RdRp an interesting target for developing the antiviral treatment. Hence the current work is concerned with the green synthesis, characterization and docking study with the RdRp enzyme of the series of novel and diverse hydrazones and pyrazoles. 4-Methyl-2-(2-(1-phenylethylidene)hydrazineyl)thiazole-5-carbohydrazide was prepared and then condensed with different carbonyl compounds (aldehydes and ketones either carbocyclic aromatic or heterocyclic) afforded the corresponding hydrazide-hydrazones. The combination of the acid hydrazide with bifunctional reagents such as acetylacetone, ß-ketoesters (ethyl acetoacetate and ethyl benzoylacetate) resulted in the formation of pyrazole derivatives. The synthesized compounds were all obtained through grinding method using drops of AcOH. Various analytical and spectral analyses were used to determine the structures of the prepared compounds. Molecular Operating Environment (MOE®) version 2014.09 was used to estimate interactions between the prepared thiazole/hydrazone hybrids and RdRp obtained from the protein data bank (PDB: 7bv2) using enzyme-ligand docking for all synthesized derivatives and Remdesivir as a reference. Docking results with the RdRp enzyme revealed that the majority of the investigated drugs bind well to the enzyme via various types of interactions in comparison with the reference drug.

The Mutational Landscape of SARS-CoV-2 Variants of Concern Recovered From Egyptian Patients in 2021.

In December 2019, a mysterious viral pneumonia first developed in Wuhan, China, resulting in a huge number of fatal cases. This pneumonia, which was named COVID-19, was attributed to a novel coronavirus, SARS-CoV-2. The emerging SARS-CoV-2 mutations pose the greatest risk to human health because they could result in an increase in the COVID-19 severity or the failure of current vaccines. One of these notable mutations is the SARS-CoV-2 Delta variant (B.1.617) that was first detected in India and has rapidly expanded to 115 countries worldwide. Consequently, in this study, we performed next-generation sequencing and phylogenetic analysis of SARS-CoV-2 during the third wave of the pandemic to determine the SARS-CoV-2 variants of concern (VOC) prevalence in Egypt. We observed several mutational patterns, revealing that SARS-CoV-2 evolution has expanded in Egypt with a considerable increase in the number of VOC. Therefore, the Egyptian authorities should take an appropriate approach to investigate the compatibility of already employed vaccines with this VOC and to examine the efficacy of the existing therapeutic regimen against new SARS-CoV-2 variants.

Does Tocilizumab Influence the Outcome of Patients with COVID-19 Pneumonia Compared to the Standard Therapy? Retrospective Analysis of Data Obtained during Phase I COVID Pandemic

BACKGROUND: No gold standard therapy was approved globally for COVID-19 pneumonia to the date of this study. The pathophysiology of SARS-CoV-2 infection displayed the predominance of hyperinflammation and immune dysregulation in inducing multiorgan damage. Therefore, the potential benefits of both immune modulation and suppression in COVID-19 have been extensively discussed as a modality to control cytokine release syndrome (CRS). Abnormally high levels of interleukin-6 (IL-6) are a common finding in COVID-19 patients with pneumonia and acute respiratory distress syndrome, so the use of IL-6 antagonist was tested as a therapeutic option in controlling the disease. Tocilizumab is a recombinant humanized anti-human IL-6 receptor monoclonal antibody that can specifically bind the membrane-bound IL-6 receptor and soluble IL-6 receptor, thereby inhibiting signal transduction. Tocilizumab is currently FDA approved for the management of rheumatoid arthritis, giant cell arthritis, polyarticular juvenile idiopathic arthritis, and systemic juvenile idiopathic arthritis. This study is a retrospective analysis of data polled during Phase I of COVID pandemic, adopted by the isolation hospital of Kasr Al-Ainy Medical School, Cairo University, during the period from May to September 2020. AIM: The aim of this study is to evaluate tocilizumab influence in the outcome;in terms of reducing the hospital stay, risk and duration of mechanical ventilation (invasive and noninvasive), mortality, and the incidence of complications related to drugs use (secondary bacterial infection and GIT bleeding) in patients with moderate-to-severe COVID-19. METHODS: This retrospective, observational cohort study included adults (between 18 and 80 years) with moderate-to-severe COVID-19 pneumonia, who were admitted to isolation hospital of Kasr Al-Ainy Medical School, Cairo University, between May and September 2020. We segregated the patients into two groups: Group A: In addition to the standard care protocol according to the local guidelines of the Egyptian Ministry of Health and Population in that period (supplemental oxygen, steroids in a dose of 1–2 mg/kg methylprednisolone for 5–10 days, broad-spectrum antibiotics, vitamins, and prophylactic dose of anticoagulation with low-molecular-weight heparin, proton-pump inhibitor, and poly-vitamins), they received tocilizumab intravenously in a dose of 8 mg/kg bodyweight (up to a maximum of 800 mg per dose), divided in two shots 12–24 h apart. Group B: Those received the standard care protocol alone, noting that guidelines were adjusted later on according to the updated scientific publications and WHO recommendations. The primary endpoint was to evaluate the effect of different regimens in controlling the disease, the need for mechanical ventilation and its duration (either invasive or non-invasive), length of ICU stay, hospital stay, and in-hospital mortality. Comparisons between quantitative variables were done using the non-parametric Mann–Whitney U-test. For comparison of serial measurements within each patient, the non-parametric Wilcoxon signed-rank test was used. For comparing categorical data, Chi-square (2) test was performed. Exact test was used instead when the expected frequency was <5. Correlations between quantitative variables were done using Spearman correlation coefficient. RESULTS: During this period, 166 patients were admitted to ICU, suffering from severe hypoxemia with moderate to severe COVID-19 pneumonia, 10 of them were excluded (three were over 80 years old, other three had advanced stages of malignancy, two were on steroids therapy and non-invasive home ventilation due to chronic chest condition, and two were presented with MODs and deceased in <48 h from admission), thus, 156 were included in the study. Group A: Seventy-six patients (49%) received tocilizumab in addition to standard therapy, Group B: Eighty patients (51%) received standard therapy only. In Group A, the mean length of ICU stay was 8.96 days with mean length of hospital stay 13.76, compared to mean length f ICU stay 9 days in Group B (p = 0.57) and mean length of hospital stay 12.46 days (p = 0.117). In Group A, 35 patients (46%) needed non-invasive mechanical ventilation (MV),12 patients of the 35 needed invasive MV in later stage, compared to 26 patients (32%) in Group B, 14 patients of the 26 needed invasive MV in later stage (p = 0.16). In Group A, 14 patients (18.4%) needed invasive mechanical ventilation, compared to 19 patients (23.7%) in Group B (p = 0.213). In Group A, 6 (7.9%) of 76 patients died, compared to 13 (16.3%) of 80 in Group B p = 0.11. The incidence of secondary bacterial infection in Group A was 16 patients (21%) compared to 21 (26%) in Group B (p = 0.44). CONCLUSION: In this study, we did not detect statistical difference in both groups of patients coming during CRS-associated COVID-19 pneumonia, regarding (ICU stay, need for and length of MV, the incidence of secondary bacterial infection, and in-hospital mortality) for COVID-19 moderate-to-severe pneumonia.

COVID-19 risk score as a public health tool to guide targeted testing: A demonstration study in Qatar.

We developed a Coronavirus Disease 2019 (COVID-19) risk score to guide targeted RT-PCR testing in Qatar. The Qatar national COVID-19 testing database, encompassing a total of 2,688,232 RT-PCR tests conducted between February 5, 2020-January 27, 2021, was analyzed. Logistic regression analyses were implemented to derive the COVID-19 risk score, as a tool to identify those at highest risk of having the infection. Score cut-off was determined using the ROC curve based on maximum sum of sensitivity and specificity. The score's performance diagnostics were assessed. Logistic regression analysis identified age, sex, and nationality as significant predictors of infection and were included in the risk score. The ROC curve was generated and the area under the curve was estimated at 0.63 (95% CI: 0.63-0.63). The score had a sensitivity of 59.4% (95% CI: 59.1%-59.7%), specificity of 61.1% (95% CI: 61.1%-61.2%), a positive predictive value of 10.9% (95% CI: 10.8%-10.9%), and a negative predictive value of 94.9% (94.9%-95.0%). The concept and utility of a COVID-19 risk score were demonstrated in Qatar. Such a public health tool can have considerable utility in optimizing testing and suppressing infection transmission, while maximizing efficiency and use of available resources.

Can New Series of Half-sandwich Lanthanum(III), Erbium(III), and Ytterbium(III) Complexes of Organometallic Ferrocenyl Schiff Base Ligands Display Biological Activities as Antibacterial and Anticancer Drugs?

A new series of La(III), Er(III), and Yb(III) complexes were synthesized from ferrocenyl Schiff base ligands (2-(1-((8-aminonaphthalen-1-yl)imino)ethyl)cyclopenta-2,4-dien-1-yl) (cyclopenta-2,4-dien-1-yl)iron (L-1) and (2-(1-((1-carboxyethyl)imino)ethyl) cyclopenta-2,4-dien-1-yl)(cyclopenta-2,4-dien-1-yl)iron (HL2). Complexes were designed, synthesized, and characterized using various spectroscopic techniques. Molar conductance data exposed that the complexes were electrolytes except La(III)-HL2 complex, which was non-electrolyte. IR spectra denoted that Schiff bases were coordinated with transition metal ions in a bidentate manner, N,N donor sites with L-1 and N,O donor sites with HL2. All complexes were octahedral and prepared in a 1:1 molar ratio with the ligands. Thermal behavior of the complexes was studied. The in vitro antibacterial activities of these compounds were evaluated against eight bacterial species such as four Gram positive bacteria (Staphylococcus aureus, Bacillus cereus, Bacillus subtilis, Streptococcus faecalis), and four Gram negative bacteria (Escherichia coli, Pseudomonas aeruginosa, Neisseria gonorrhoeae, Salmonella typhimurium) and results displayed that title compounds are biologically active. Also, they were assessed for their anticancer activities against cell line MCF-7 for breast cancer. Finally, molecular docking studies were tested for all prepared compounds with two different COVID-19 receptors (7BZ5 and 7C8J), also, against 3HB5 receptor of breast cancer. Molecular docking has shown favorable interaction between the title compounds and three protein receptors. This paper affords a manifestation of a novel tradition by which Comments on Inorganic Chemistry starts publishing original research content that, nonetheless, preserves the Journal's identity as a niche for a critical discussion of contemporary literature in inorganic chemistry;for previous manifestations, see Comments Inorg. Chem. 2020, 40, 277-303, and references cited in the thereof.