Immunogenicity and In Vivo Protective Effects of Recombinant Nucleocapsid-Based SARS-CoV-2 Vaccine Convacell®.

The vast majority of SARS-CoV-2 vaccines which are licensed or under development focus on the spike (S) protein and its receptor binding domain (RBD). However, the S protein shows considerable sequence variations among variants of concern. The aim of this study was to develop and characterize a SARS-CoV-2 vaccine targeting the highly conserved nucleocapsid (N) protein. Recombinant N protein was expressed in Escherichia coli, purified to homogeneity by chromatography and characterized by SDS-PAGE, immunoblotting, mass spectrometry, dynamic light scattering and differential scanning calorimetry. The vaccine, formulated as a squalane-based emulsion, was used to immunize Balb/c mice and NOD SCID gamma (NSG) mice engrafted with human PBMCs, rabbits and marmoset monkeys. Safety and immunogenicity of the vaccine was assessed via ELISA, cytokine titer assays and CFSE dilution assays. The protective effect of the vaccine was studied in SARS-CoV-2-infected Syrian hamsters. Immunization induced sustainable N-specific IgG responses and an N-specific mixed Th1/Th2 cytokine response. In marmoset monkeys, an N-specific CD4+/CD8+ T cell response was observed. Vaccinated Syrian hamsters showed reduced lung histopathology, lower virus proliferation, lower lung weight relative to the body, and faster body weight recovery. Convacell® thus is shown to be effective and may augment the existing armamentarium of vaccines against COVID-19.

Efficiency of Online Learning during Covid-19 Pandemic

COVID-19 pandemic has had a profound effect on campuses, compelling learning systems to shift away from face-to-face engagement and toward online instruction. The purpose of this research is to investigate the effectiveness of remote learning in the event of a COVID-19 pandemic. To obtain responses, a self-administered online survey was used. After data screening, 315 data were proceeded to the next analysis. Additionally, the data were devoid of missing cases and outliers. The measuring model was evaluated for indicator and internal consistency reliability, convergent and discriminant validity. Meanwhile, the structural model was evaluated by SmartPLS version 3.2.9 utilising the bootstrapping approach. Findings revealed self-discipline and flexibility were significant towards effectiveness of online learning among students at the UiTM Kelantan, Kota Bharu Campus. The findings argue that, in the modern era, internet technologies have increased the flexibility of post secondary education in a variety of ways. Institutions should make strategic use of these new flexibility, concentrating on chances to engage students more deeply in learning that results in practical outcomes. © 2023, World Scientific and Engineering Academy and Society. All rights reserved.

Depression, anxiety, and physical activity among antenatal women during COVID-19 pandemic

The prevalence of mental health problems among antenatal women has escalated during the COVID-19 pandemic compared to the pre-pandemic period. Physical activity palys role to reduce depression and anxiety, which required to be studied further. This study aimed to assess the association between physical activity with depression and anxiety among antenatal women during the COVID-19 pandemic. This cross-sectional study applied convenience sampling to recruit 544 antenatal women from March to June 2021. Questionnaires including the Edinburgh postnatal depression scale (EPDS), state-trait anxiety inventory (STAI), and pregnancy physical activity questionnaire (PPAQ) were distributed via social media to determine the prevalence of depression, anxiety, and physical activity level. Data were analysed using descriptive statistics, chi-square, mann-whitney, and kruskal wallis tests. Out of 544 antenatal women, 24.1% of them had depressive symptoms and 82.4% had anxiety. Only 12.1% of the women were sufficiently active during the pandemic. There was no association between physical activity, depression, and anxiety. The high prevalence of depression and anxiety during the COVID-19 pandemic among Malaysian antenatal women underscores the urgent need for addressing this public health burden. Interventions to alleviate the symptoms should include strategies beyond physical activity, for example, a mobile application or telephone-delivered social support that is made easily accessible throughout the pandemic. © 2022, Intelektual Pustaka Media Utama. All rights reserved.

Efficiency of Online Learning during Covid-19 Pandemic

COVID-19 pandemic has had a profound effect on campuses, compelling learning systems to shift away from face-to-face engagement and toward online instruction. The purpose of this research is to investigate the effectiveness of remote learning in the event of a COVID-19 pandemic. To obtain responses, a self-administered online survey was used. After data screening, 315 data were proceeded to the next analysis. Additionally, the data were devoid of missing cases and outliers. The measuring model was evaluated for indicator and internal consistency reliability, convergent and discriminant validity. Meanwhile, the structural model was evaluated by SmartPLS version 3.2.9 utilising the bootstrapping approach. Findings revealed self-discipline and flexibility were significant towards effectiveness of online learning among students at the UiTM Kelantan, Kota Bharu Campus. The findings argue that, in the modern era, internet technologies have increased the flexibility of post secondary education in a variety of ways. Institutions should make strategic use of these new flexibility, concentrating on chances to engage students more deeply in learning that results in practical outcomes. © 2023, World Scientific and Engineering Academy and Society. All rights reserved.

Depression, Anxiety, and Behavioural Changes during the COVID-19 Pandemic among Medical and Nursing Students

During the COVID-19 pandemic, medical and nursing students are faced with various challenges such as the need to attend online classes and juggling clinical postings under the new norm. This study aimed to assess the association between depression, anxiety, and behavioural changes among medical and nursing students during the COVID-19 pandemic. An online self-administered questionnaire was distributed between March 2021 and July 2021 to 292 undergraduates medical and nursing students in a higher education institute on the East Coast of Malaysia. The questionnaires consisted of four parts: sociodemographic data, the Generalised Anxiety Disor-der-7, the Patient Health Questionnaire-9, and questions related to behaviours during the COVID-19 pandemic. This study found that 23.6% and 33.6% of the students experienced anxiety and depression respectively, possibly caused by the COVID-19 pandemic. Anxiety was associated with a high level of behavioural changes during the pandemic with a total of 87% of the students showing behavioural changes. Therapeutic interventions such as online counselling and consultation should be implemented by the university to reduce the prevalence of depression and anxiety resulting from the COVID-19 pandemic among medical and nursing students. © 2022, Tech Science Press. All rights reserved.

Pseudothrombotic microangiopathy and pancytopenia as a rare presentation of vitamin B12 deficiency

Case Report A 62-year-old male presented to our hospital with a few days of worsening dyspnea, associated with numbness in the left lower extremity, dizziness and transient brief chest pain that was described as a sharp intermittent pain. He denied any fever, chills, nausea, vomiting, diarrhea, headache, or recent ill contacts. The patient also denied any family history of blood or bone morrow disease. He had been released from incarceration 2 days prior to the presentation. Complete blood count revealed pancytopenia with hemoglobin of 6.8 g/dL, MCV of 112 fL, white blood cell count of 1.2 K/uL, and platelet count of 78 K/uL. The patient was transfused with packed red blood cells and then admitted to the inpatient medicine ward for further treatment and evaluation. Blood smear confirmed the pancytopenia with severe neutropenia, macrocytosis, and moderate thrombocytopenia. In addition, it showed erythrocytes with marked poikilocytosis including occasional schistocytes and teardrop cells. His lab investigations were notable for B12 level below 150 pg/mL (Normal range 211-911), fibrinogen of 144 mg/dL , haptoglobin less than 10 mg/dL, LDH of 1013 U/L. Other lab studies including troponin, ferritin, TIBC, serum iron, vitamin B1, PT/INR, PTT, SPEP, COVID-19, EBV, CMV, HIV, Hepatitis A, B, and C were all unrevealing. Abdominal ultrasound was significant for splenomegaly. CT head and chest xray were unremarkable. After starting treatment with cobalamin therapy, the patient has shown improvement in terms of cell counts, resolution of hemolysis. He also reported significant improvement in tingling and dizziness. All this confirms the diagnosis. Vitamin B12 deficiency manifestations can vary between asymptomatic, mild, and severe. In our case, the patient presented with pseudothrombotic microangiopathy and pancytopenia. Both are rare and serious manifestations of vitamin B12 deficiency. Physicians should be aware of cobalamin deficiency as one of the etiologies for pancytopenia and pseudothrombotic microangiopathy. Therefore, an early recognition and treatment is crucial. (Figure Presented).

The Diagnosis of COVID-19 by Means of Transfer Learning through X-ray Images

Radiography is used in medical treatment as a method to diagnose the internal organs of the human body from diseases. However, the advancement in machine learning technologies have paved way to new possibilities of diagnosing diseases from chest X-ray images. One such diseases that are able to be detected by using X-ray is the COVID-19 coronavirus. This research investigates the diagnosis of COVID-19 through X-ray images by using transfer learning and fine-tuning of the fully connected layer. Hyperparameters such as dropout, p, number of neurons, and activation functions are investigated on which combinations of these hyperparameters will yield the highest classification accuracy model. VGG19 learning model created by the Visual Geometry Group is used for extraction of features from the patient's chest X-ray images. To evaluate the combination of various pipelines, the loss and accuracy graphs are used to find the pipeline which performs the best in classification task. The findings in this research will open new possibilities in screening method for COVID-19.

GUILLAIN-BARRÉ SYNDROME FOLLOWING COVID-19 PNEUMONIA: ARE THEY RELATED?

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Guillain-Barré syndrome (GBS) is an immune-mediated polyneuropathy affecting the peripheral nervous system. Immune system activation in response to a viral or bacterial infection, which cross-reacts with the peripheral nerve components, is GBS's proposed mechanism. Epstein-Barr virus, campylobacter, cytomegalovirus, influenza, and mycoplasma are the most commonly associated infections with GBS development. Since the beginning of the coronavirus 2019 (COVID-19) pandemic, there have been isolated reports of the disease's neurological manifestations and sequelae. In early February 2020 itself, COVID-19 associated GBS has been reported from Italy and China. Here we are reporting the case of a GBS after severe COVID-19 pneumonia. CASE PRESENTATION: A 68-year- old Caucasian male with a history of obstructive sleep apnea, hypertension, and restless leg syndrome came to the hospital with worsening reparatory difficulty. He was diagnosed with COVID-19 pneumonia a week ago and was on remdesivir and dexamethasone therapy at home. At the time of presentation, he was found to be in respiratory failure, which eventually required intubation and mechanical ventilation. After spending 14 days on mechanical ventilation, the patient was extubated. His respiratory status significantly improved, but he was found to have confused mentation on day two after extubation. An MRI scan and EEG showed no significant abnormality. His confusion improved over the next two days, but he gradually developed bilateral upper and lower extremity symmetrical weaknesses with loss of deep tendon reflexes and touch sensation. The patient was also found to have alternating tachycardia and bradycardia around this period. The weakness progressed over the next week. CSF analysis revealed a protein level of 77mg/dL (normal: 8–43 mg/dL) with total nucleated cells of 3 (normal 0-8 ). CSF meningitis/encephalitis PCR panel for the 17 most common pathogens was negative (the panel did not have COVID-19). Nerve conduction studies were not done due to lack of availability. A diagnosis of GBS was made, and the patient was transferred to a higher center for plasmapheresis. DISCUSSION: COVID-19 leading to GBS does not come as a surprise;similar viruses, including Severe acute respiratory syndrome coronavirus and middle east respiratory syndrome coronavirus, had been reported to trigger GBS. If the CSF findings and autonomic nervous system involvement were absent, post-intensive care syndrome and critical care neuropathy might have been close differentials. There are isolated reports of blood transfusions leading to GBS;although unlikely, the patient's reception of convalescent plasma cannot be overlooked. The absence of nerve conduction studies also truncates the confidence of GBS diagnosis here. CONCLUSIONS: GBS may be triggered by COVID-19 infection, although more evidence is needed to establish the causation. REFERENCE #1: Caress JB, Castoro RJ, Simmons Z, Scelsa SN, Lewis RA, Ahlawat A, Narayanaswami P. COVID-19-associated Guillain-Barré syndrome: The early pandemic experience. Muscle Nerve. 2020 Oct;62(4):485-491. doi: 10.1002/mus.27024. Epub 2020 Aug 11. PMID: 32678460;PMCID: PMC7405390. REFERENCE #2: Rajdev K, Victor N, Buckholtz ES, Hariharan P, Saeed MA, Hershberger DM, Bista S. A Case of Guillain-Barré Syndrome Associated With COVID-19. J Investig Med High Impact Case Rep. 2020 Jan-Dec;8:2324709620961198. doi: 10.1177/2324709620961198. PMID: 32981333;PMCID: PMC7545753. REFERENCE #3: Scheidl E, Canseco DD, Hadji-Naumov A, Bereznai B. Guillain-Barré syndrome during SARS-CoV-2 pandemic: A case report and review of recent literature. J Peripher Nerv Syst. 2020 Jun;25(2):204-207. doi: 10.1111/jns.12382. Epub 2020 May 26. PMID: 32388880;PMCID: PMC7273104. DISCLOSURES: No relevant relationships by Arthur Cecchini, source=Web Response No relevant relationships by Bhavesh Gajjar, source=Web Response No relevant relationships by Rasheed Musa, source=Web Response No relevant relati nships by Akesh Thomas, source=Web Response

Promising compounds from natural sources against COVID-19

The epidemic associated with the new Sars-CoV-2 coronavirus has affected almost all countries of the world and no reliable treatment for this infection exists yet. Many laboratories in the world are currently conducting intensive experimental and theoretical/in silico studies to find effective drugs specific for this disease (COVID-19), but unfortunately, it may take a long time before new drugs appear in the clinical practice. One of the currently widely accepted approaches for finding active compounds is based on the possibility of using existing drugs approved by government medical organizations (as the FDA). Their choice is based on screening, based on the use of computer models that evaluate the specific binding (energy minimization) of such drugs to target molecules that are important for the life cycle. Thus, a few well-known antiviral drugs against HIV, hepatitis C and others selected on this basis exerted an antiviral effect in vitro, but their real effectiveness was far from expected. It should be emphasized that the severe clinical manifestation of the disease is an acute respiratory distress syndrome, mediated by oxidative stress and an aggressive immune attack on its own cells. In this regard, the use of compounds with high antioxidant activity could have advantages both prophylactically and medically. There is a huge range of natural compounds, including official and traditional medicine, which represent valuable unlimited potential for COVID-19 therapy, the advantage of such compounds in their low toxicity. In this review, we tried to focus on the clinical and pharmacological properties of natural substances, mainly flavonoids, which can become promising drugs for the treatment and prevention of COVID-19. The review includes information on possible virus targets and antiviral drugs. Much attention is paid to the question of inhibition of viral activity. Based on published data, including structural features of various compounds, a prediction is made about the prospects of using these compounds as inhibitors of viral activity, as well as anti-inflammatory drugs for the treatment of COVID-19. An important step in the analysis of compounds was the study of the possibility of their interaction with cellular targets of the virus, as well as the ability to bind to the proteins of the Sars-CoV-2 virus itself. Эпидемия, связанная с новым коронавирусом Sars-CoV-2, поразила практически все страны земного шара, и надежных лечебных средств от этой инфекции пока не существует. Многие лаборатории в мире в настоящее время ведут интенсивные экспериментальные и теоретические исследования с целью поиска эффективных препаратов, специфичных для этого заболевания (COVID-19), но, к сожалению, может потребоваться много времени, прежде чем новые лекарства появятся в клинической практике. Один из самых популярных подходов основан на возможности использования для лечения существующих препаратов, одобренных правительственными медицинскими организациями. Их выбор основан на скрининге, в основе которого лежит использование компьютерных моделей, оценивающих специфическое связывание (минимизация энергии связывания) таких препаратов с молекулами-мишенями, важных для жизненного цикла. Так, ряд известных антивирусных препаратов против ВИЧ, гепатита С, выбранных подобным образом, оказывали противовирусный эффект in vitro, но их клиническая эффективность была невысокой. Следует подчеркнуть, что тяжелая форма клинического проявления заболевания представляет собой острый респираторный дистресс-синдром, опосредованный окислительным стрессом и агрессивной иммунной атакой на собственные клетки. В этой связи применение соединений с высокой антиоксидантной активностью может иметь преимущества как в профилактическом, так и в лечебном плане. Существует огромный спектр природных соединений, включая препараты официальной и традиционной медицины, которые представляют неограниченный потенциал, в том числе для терапии вирусных заболеваний. Основным преимуществом подобных соединений является их низкая токсичность. В данном обзоре мы постарались сделать акцент на клинические и фармакологические свойства природных веществ, преимущественно флавоноидов, которые могут стать перспективными препаратами для лечения и профилактики COVID-19. В обзор включена информация о возможных мишенях вируса и противовирусных препаратах. Большое внимание уделено вопросу ингибирования вирусной активности. На основе литературных данных, в том числе о структурных особенностях различных соединений, сделан прогноз о перспективности использования данных соединений в качестве ингибиторов вирусной активности, а также в качестве противовоспалительных средств для терапии COVID-19. Важным этапом при анализе соединений было изучение возможности их взаимодействия с клеточными мишенями вируса, а также способности связывания с белками самого вируса Sars-CoV-2.