The association between inflammatory and immune system biomarkers and the dietary inflammatory index in patients with COVID-19.

Background: Inflammation and cytokine storm have been reported to be the main cause of acute symptoms of coronavirus disease (COVID-19). Diet-induced inflammation may affect the condition of patients with COVID-19. Therefore, this study aimed to investigate the relationship between disease severity, inflammatory and immune system biomarkers, and the dietary inflammatory index (DII) in patients with COVID-19. Methods: This cross-sectional study was conducted on 500 adult patients with COVID-19. Patients were divided into mild, moderate, and severe conditions based on clinical and laboratory evidence. A validated food frequency questionnaire (FFQ) was used to determine DII and energy-adjusted DII (E-DII) scores. The serum C-reactive protein (CRP) level and blood cell count were measured for all patients. Multiple linear regression was used to explore the association between DII and E-DII and CRP, blood cell counts, and hospitalization in patients with COVID-19. Results: Coronavirus disease (COVID-19) patients with higher DII had higher consumption of fat and carbohydrate and lower intakes of protein, anti-inflammatory nutrients, garlic, caffeine, tea, onion, and fiber (P < 0.05). There was a positive association between DII and CRP (ß = 1.024, P < 0.001), hospitalization (ß = 1.062, P < 0.001), WBC count (ß = 0.486, P < 0.009), neutrophil count (ß = 0.565, P < 0.001), and neutrophil-to-lymphocyte ratio (ß = 0.538, P < 0.001) and a negative association between DII and the lymphocyte count (ß = -0.569, P < 0.001). There was a positive association between E-DII and hospitalization (ß = 1.645, P < 0.001), WBC count (ß = 0.417, P < 0.02), and neutrophil-to-lymphocyte ratio (ß = 0.35, P < 0.03). Conclusion: There is a positive correlation between DII and inflammation, immune hyperactivation, and length of hospital stay in patients with COVID-19. Further longitudinal studies are necessary.

Investigation of the Molecular Mechanism of Coagulopathy in Severe and Critical Patients With COVID-19.

Coagulopathy is a frequently reported finding in the pathology of coronavirus disease 2019 (COVID-19); however, the molecular mechanism, the involved coagulation factors, and the role of regulatory proteins in homeostasis are not fully investigated. We explored the dynamic changes of nine coagulation tests in patients and controls to propose a molecular mechanism for COVID-19-associated coagulopathy. Coagulation tests including prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen (FIB), lupus anticoagulant (LAC), proteins C and S, antithrombin III (ATIII), D-dimer, and fibrin degradation products (FDPs) were performed on plasma collected from 105 individuals (35 critical patients, 35 severe patients, and 35 healthy controls). There was a statically significant difference when the results of the critical (CRT) and/or severe (SVR) group for the following tests were compared to the control (CRL) group: PTCRT (15.014) and PTSVR (13.846) (PTCRL = 13.383, p < 0.001), PTTCRT (42.923) and PTTSVR (37.8) (PTTCRL = 36.494, p < 0.001), LACCRT (49.414) and LACSVR (47.046) (LACCRL = 40.763, p < 0.001), FIBCRT (537.66) and FIBSVR (480.29) (FIBCRL = 283.57, p < 0.001), ProCCRT (85.57%) and ProCSVR (99.34%) (ProCCRL = 94.31%, p = 0.04), ProSCRT (62.91%) and ProSSVR (65.06%) (ProSCRL = 75.03%, p < 0.001), D-dimer (p < 0.0001, χ2 = 34.812), and FDP (p < 0.002, χ2 = 15.205). No significant association was found in the ATIII results in groups (ATIIICRT = 95.71% and ATIIISVR = 99.63%; ATIIICRL = 98.74%, p = 0.321). D-dimer, FIB, PT, PTT, LAC, protein S, FDP, and protein C (ordered according to p-values) have significance in the prognosis of patients. Disruptions in homeostasis in protein C (and S), VIII/VIIIa and V/Va axes, probably play a role in COVID-19-associated coagulopathy.

Effects of high-speed wind, humidity, and temperature on the generation of a sars-cov-2 aerosol;a novel point of view

The new coronavirus (SARS-CoV-2) is rapidly spreading across communities around the world. Respiratory droplet transmission is a common transmission route for many airborne diseases, including novel coronavirus disease (COVID-19). Wearing the face mask prevents respiratory droplet transmission. Both face mask leakage and non-use of the face mask under high-speed wind conditions can increase the risk of SARS-CoV-2 transmission. The respiratory droplets’ behavior during sneezing or coughing (i.e., the size and the distance between droplets) depends on face mask wearing. The respiratory droplets during coughing and sneezing break apart into extremely small respiratory droplets (i.e., cloud of aerosol) upon interaction with the high-speed wind condition. The volume-of-fluid (VOF) method has been used to study the deformation and breakup of a single respiratory droplet placed in high-speed wind flow in the presence of smaller neighboring respiratory droplets. The effect of the diameter of respiratory droplets and the distance between them on the breakup mechanism has been investigated using open-source field operation and manipulation (OpenFOAM) libraries. The results are presented for the dimensionless distance and the normalized diameter of the secondary respiratory droplet in the ranges of 2 to 6 and 0.4 to 0.8, respectively. According to the results of simulations, the spreading of SARS-CoV-2 increases with a decrease in respiratory droplet breakup time. In addition, the effects of ambient relative humidity and temperature on the cloud of respiratory particles were analyzed. © 2021, AAGR Aerosol and Air Quality Research. All rights reserved.

Evaluation of epidemiology, clinical features, prognosis, diagnosis and treatment outcomes of patients with COVID-19 in West Azerbaijan Province.

BACKGROUND: COVID-19 is considered a widespread concern in global public health. Diagnoses of COVID-19 in some cases are necessary because of severe prognosis. In this study, epidemiologies, clinical and demographic characteristics of patients with COVID-19 were studied in Taleghani Hospital, Urmia, Iran. METHODS: This descriptive-analytical cross-sectional study was carried out on 215 patients with COVID-19 during March and April 2020. Approved COVID-19 case was considered as a person with a positive respiratory sample performed by at least one of two RT-PCR methods or genetic sequencing. ANOVA repeated measure, independent t-test and logistic regression were done. A P < .05 was considered significant. RESULTS: The mean age of patients was 50.93 ± 17.92 years. Regarding gender, there were 91 females (42.3%) and 124 males (57.7%). The mean hospital stay, the temperature at admission, and onset of symptoms were 4.91 ± 3.68 days, 37.40 ± 0.96°C and 5.88 ± 4.80 days, respectively. Close contact with suspected people was found in 10.2% of patients. Additionally, 44 patients (20.5%) were smokers. Shortness of breath and cough were found in 62.8% and 49.3% of patients. Diabetes mellitus and hypertension were the most common comorbidities of patients. Regarding lung involvement, 33 patients (33%) were normal, most of the patients (n = 71) had 5%-25% involvement in their lung and a minority of patients (n = 13) had a severe condition of 50%-75% lung involvement. The association between smoking and mortality was tested using chi-square showing no significant difference (X2 :2.959, P = .085). There was no significant difference between AST, ALT, ALP, total, direct Bilirubin, lung involvement and suffering from fever (P > .05). High Spo2 can increase the chance of recovery by 24% with each unit reduction. Kidney involvement increases the chance of death by about 80% (95% CI: 0.104-0.013). The odds ratio of spo2 for recovery of COVID-19 was 1.24 (95% CI: 1.014-1.528; P = .037). Kaletra with odds ratio of 31.960 had the most highest effect on recovery following COVID-19 (P = .043). CONCLUSION: COVID-19 involves different organs of the body with different severity. In the meantime, smoking was not a risk factor for the virus or associated with severe manifestations of the disease. Patients with high creatinine and CPK, pulmonary involvement above 25%, and hypoxemia had a higher mortality rate. Increase of Spo2 by 1% can improve the patients by 24%. The results indicated that Kaletra had the most highest effect on improvement following COVID-19.

Severe acute respiratory syndrome coronavirus-2- or pregnancy-related cardiomyopathy, a differential to be considered in the current pandemic: a case report.

BACKGROUND: There are limited data on cardiovascular complications of coronavirus disease 2019 in pregnancy, and there are only a few case reports on coronavirus disease 2019 related cardiomyopathy in pregnancy. Differentiation between postpartum cardiomyopathy and coronavirus disease 2019 related cardiomyopathy in pregnant women who develop severe acute respiratory syndrome coronavirus-2 infection during peripartum could be challenging. Here, we present a case of possible coronavirus disease 2019 related cardiomyopathy in a pregnant patient, followed by a discussion of potential differential diagnosis. CASE PRESENTATION: In this case report, we present the case of a young pregnant Iranian woman who developed heart failure with pulmonary edema after cesarean section. She was treated because of low left ventricular ejection fraction and impression of postpartum cardiomyopathy, and her severe dyspnea improved by intravenous furosemide. On day 3, she exhibited no orthopnea or leg edema, but she was complaining of severe and dry cough. Further evaluation showed severe acute respiratory syndrome coronavirus-2 infection. CONCLUSIONS: The possibility of severe acute respiratory syndrome coronavirus-2 infection should be considered in any pregnant woman who develops cardiomyopathy and pulmonary edema.

Correction to: The use of intravenous immunoglobulin gamma for the treatment of severe coronavirus disease 2019: a randomized placebo-controlled double-blind clinical trial.

An amendment to this paper has been published and can be accessed via the original article.

The use of intravenous immunoglobulin gamma for the treatment of severe coronavirus disease 2019: a randomized placebo-controlled double-blind clinical trial.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has infected people in many countries worldwide. Discovering an effective treatment for this disease, particularly in severe cases, has become the subject of intense scientific investigation. Therefore, the objective of this study was to evaluate the efficacy of intravenous immunoglobulin (IVIg) in patients with severe COVID-19 infection. METHODS: This study was conducted as a randomized placebo-controlled double-blind clinical trial. Fifty-nine patients with severe COVID-19 infection who did not respond to initial treatments were randomly assigned into two groups. One group received IVIg (human)-four vials daily for 3 days (in addition to initial treatment), while the other group received a placebo. Patients' demographic, clinical, and select laboratory test results, as well as the occurrence of in-hospital mortality, were recorded. RESULTS: Among total study subjects, 30 patients received IVIg and 29 patients received a placebo. Demographics, clinical characteristics, and laboratory tests were not statistically different (P > 0.05) between the two groups. The in-hospital mortality rate was significantly lower in the IVIg group compared to the control group (6 [20.0%] vs. 14 [48.3%], respectively; P = 0.022). Multivariate regression analysis demonstrated that administration of IVIg did indeed have a significant impact on mortality rate (aOR = 0.003 [95% CI: 0.001-0.815]; P = 0.042). CONCLUSIONS: Our study demonstrated that the administration of IVIg in patients with severe COVID-19 infection who did not respond to initial treatment could improve their clinical outcome and significantly reduce mortality rate. Further multicenter studies with larger sample sizes are nonetheless required to confirm the appropriateness of this medication as a standard treatment. TRIAL REGISTRATION: A study protocol was registered at the Iranian Registry of Clinical Trials ( www.IRCT.ir ), number IRCT20200501047259N1 . It was registered retrospectively on May 17th, 2020.

A novel methodology and new concept of SARS-CoV-2 elimination in heating and ventilating air conditioning systems using waste heat recovery.

Heating and ventilation air conditioning systems in hospitals (cleanroom HVAC systems) are used to control the transmission/spreading of airborne diseases such as COVID-19. Air exiting from these systems may contribute to the spreading of coronavirus droplets outside of hospitals. Some research studies indicate that the shortest time of survival of SARS-CoV-2 in aerosol form (as droplets in the air) is four hours and the virus becomes inactive above 60 °C air temperature. Therefore, SARS-CoV-2 droplets cannot exit from the exhaust duct if the temperature is above 60 °C. At the condenser, heat is dissipated in the form of hot air which could be utilized to warm the exhaust air. The objective of this paper is to establish a novel technique for eliminating SARS-CoV-2 from cleanroom HVAC systems using the recovered heat of exhaust air. This can eliminate SARS-CoV-2 and reduce the greenhouse effect.