Understanding the psychological therapy treatment outcomes for young adults who are not in education, employment, or training (NEET), moderators of outcomes, and what might be done to improve them.

BACKGROUND: To determine: whether young adults (aged 18-24) not in education, employment or training (NEET) have different psychological treatment outcomes to other young adults; any socio-demographic or treatment-related moderators of differential outcomes; and whether service-level changes are associated with better outcomes for those who are NEET. METHODS: A cohort was formed of 20 293 young adults treated with psychological therapies in eight Improving Access to Psychological Therapies services. Pre-treatment characteristics, outcomes, and moderators of differential outcomes were compared for those who were and were not NEET. Associations between outcomes and the following were assessed for those that were NEET: missing fewer sessions, attending more sessions, having a recorded diagnosis, and waiting fewer days between referral and starting treatment. RESULTS: Those who were NEET had worse outcomes: odds ratio (OR) [95% confidence interval (CI)] for reliable recovery = 0.68 (0.63-0.74), for deterioration = 1.41 (1.25-1.60), and for attrition = 1.31 (1.19-1.43). Ethnic minority participants that were NEET had better outcomes than those that were White and NEET. Living in deprived areas was associated with worse outcomes. The intensity of treatment (high or low) did not moderate outcomes, but having more sessions was associated with improved outcomes for those that were NEET: odds (per one-session increase) of reliable recovery = 1.10 (1.08-1.12), deterioration = 0.94 (0.91-0.98), and attrition = 0.68 (0.66-0.71). CONCLUSIONS: Earlier treatment, supporting those that are NEET to attend sessions, and in particular, offering them more sessions before ending treatment might be effective in improving clinical outcomes. Additional support when working with White young adults that are NEET and those in more deprived areas may also be important.

3-Difluormethyl-5-carbomethoxy-2,4-pyrazole: Molecular mechanism of the formation and molecular docking study

Application of the Molecular Electron Density Theory (MEDT) for the exploration of the [3+2] cycloaddition processes between methyl propynoate 1 and difluoromethyldiazomethane T-1, have been implemented using the DFT/B3LYP/6-311(d,p) level of theory. According to an examination of conceptual DFT indices, difluoromethyldiazomethane (T-1) participates in this reaction as a nucleophile, while methyl propynoate (1) should be considered as an electrophile. This cyclization is regiospecific, as evidenced by the activation and reaction energies, this agrees with the experiment's findings. It was discovered throughout ELF analysis that analyzed [3+2] cycloaddition is realised by a two-step mechanism. In addition, study of interactions of the products studied in this paper with the protein protease Covid-19 (PDB ID: 7R98) were carried out, by means of molecular docking study). The results indicate that the occurrence of the transfer of the proton to the nitrogen atom, increases the affinity of these products to the protein (CA32-F1 and CA32-F2). © 2023.

Development and Validation of an Acute Respiratory Distress Syndrome Prediction Model in Coronavirus Disease 2019: Updated Lung Injury Prediction Score.

OBJECTIVE: To develop and validate an updated lung injury prediction score for coronavirus disease 2019 (COVID-19) (c-LIPS) tailored for predicting acute respiratory distress syndrome (ARDS) in COVID-19. PATIENTS AND METHODS: This was a registry-based cohort study using the Viral Infection and Respiratory Illness Universal Study. Hospitalized adult patients between January 2020 and January 2022 were screened. Patients who qualified for ARDS within the first day of admission were excluded. Development cohort consisted of patients enrolled from participating Mayo Clinic sites. The validation analyses were performed on remaining patients enrolled from more than 120 hospitals in 15 countries. The original lung injury prediction score (LIPS) was calculated and enhanced using reported COVID-19-specific laboratory risk factors, constituting c-LIPS. The main outcome was ARDS development and secondary outcomes included hospital mortality, invasive mechanical ventilation, and progression in WHO ordinal scale. RESULTS: The derivation cohort consisted of 3710 patients, of whom 1041 (28.1%) developed ARDS. The c-LIPS discriminated COVID-19 patients who developed ARDS with an area under the curve (AUC) of 0.79 compared with original LIPS (AUC, 0.74; P<.001) with good calibration accuracy (Hosmer-Lemeshow P=.50). Despite different characteristics of the two cohorts, the c-LIPS's performance was comparable in the validation cohort of 5426 patients (15.9% ARDS), with an AUC of 0.74; and its discriminatory performance was significantly higher than the LIPS (AUC, 0.68; P<.001). The c-LIPS's performance in predicting the requirement for invasive mechanical ventilation in derivation and validation cohorts had an AUC of 0.74 and 0.72, respectively. CONCLUSION: In this large patient sample c-LIPS was successfully tailored to predict ARDS in COVID-19 patients.

Monoclonal antibody designed for SARS-nCoV-2 spike protein of receptor binding domain on antigenic targeted epitopes for inhibition to prevent viral entry.

SARS, or severe acute respiratory syndrome, is caused by a novel coronavirus (COVID-19). This situation has compelled many pharmaceutical R&D companies and public health research sectors to focus their efforts on developing effective therapeutics. SARS-nCoV-2 was chosen as a protein spike to targeted monoclonal antibodies and therapeutics for prevention and treatment. Deep mutational scanning created a monoclonal antibody to characterize the effects of mutations in a variable antibody fragment based on its expression levels, specificity, stability, and affinity for specific antigenic conserved epitopes to the Spike-S-Receptor Binding Domain (RBD). Improved contacts between Fv light and heavy chains and the targeted antigens of RBD could result in a highly potent neutralizing antibody (NAbs) response as well as cross-protection against other SARS-nCoV-2 strains. It undergoes multipoint core mutations that combine enhancing mutations, resulting in increased binding affinity and significantly increased stability between RBD and antibody. In addition, we improved. Structures of variable fragment (Fv) complexed with the RBD of Spike protein were subjected to our established in-silico antibody-engineering platform to obtain enhanced binding affinity to SARS-nCoV-2 and develop ability profiling. We found that the size and three-dimensional shape of epitopes significantly impacted the activity of antibodies produced against the RBD of Spike protein. Overall, because of the conformational changes between RBD and hACE2, it prevents viral entry. As a result of this in-silico study, the designed antibody can be used as a promising therapeutic strategy to treat COVID-19.

Real-Time Measurement of Psychological Impact Due to E- Learning, among the Undergraduate Dental Students during Covid-19

Objectives: To assess the psychological factors in undergraduate dental students towards e-learning in clinical skills education compared to traditional teaching methods and their relationship with performance during the COVID-19 pandemic. Method(s): In this study, survey conductedamong 494undergraduate dentalstudents of all four sessions from different dental universities within the Pakistan. Total 494 undergraduate dental students responded to a 28-question online survey to identify e- learning is more convenient and practicalthan traditional learning and to measure it 5- pointLikertScaleused. To measure level of psychological impact, Hamilton Anxiety Scale used due to e-learning among undergraduate dental students. Result(s): The majority of undergraduate dental student's responded e-learning is not convenient and practical than traditional learning system. The majority of undergraduate dentalstudents reportedveryseverelevelof psychologicalimpactdueto e-learning and closing of institutions during COVID-19 pandemic. Results are statistically significant and analyzed on IBM SPSS version 23. There are 82% students responded having problem with e-learning system and among them 58 % have very severe anxiety and 24% have severe anxiety. So the results shows increased percentage of anxiety due e-learning. Conclusion(s): Dental students expressed a higher level of comfort and effective learning in a recognizable, conventional classroom circumstance. Teaching with traditional system improvesstudent'scriticalthinkingskillsandformulatesopinionsorargumentsbyengaging in live discussions. This study reveals that students face challenges in using the e-learning resources because of incompetency in the IT skills, lack of motivation and access to proper internet. The most important issue identified by this study is maintaining an effective interaction with dental students in e-learning system of teaching to fill the gap between the teacher and students. There should be further flexibility workload and learning time to students to reduce the level of anxiety among the dental students.Copyright © 2020 Ubiquity Press. All rights reserved.

Prototyping a Spatial Skills AR Authoring Tool for Partially Sighted, Blind, and Sighted Individuals

Spatial skills are critical for understanding the relations among objects and people, playing an important role in how we interact with the world. Spatial relationships are built through interactions with physical objects;however, in computational/online environments, these change to bi-dimensional media and computer-assisted design comprised of 3D representations viewable through a flat screen. Due to spatial immersion and interaction limitations, a traditional 2D and 3D approach presents challenges to partially sighted, blind, and sighted individuals. This paper presents the prototyping of a co-design Augmented Reality (AR) authoring tool by recruiting inclusive emerging affordances of consumer-level AR technologies within the context of current e-learning provisions in subject matters, including inclusive design, engineering design, game hardware design, and health sciences. This work has been inspired by the COVID-19 pandemic that has shown the need to level the field in inclusive design for teaching a subject typically oriented to the sighted. Our prototype allows users to create e-learning content for visualization, interaction, collaboration, and inclusive learning. Future work will investigate our tool's impact on skills development and content creation. © 2022 IEEE.

Assessment of post-COVID-19 clinical manifestations after recovery in healthcare professionals

Aim: In this study, we aimed to assess the COVID-19 clinical manifestations after recovery from illness among healthcare professionals. Material(s) and Method(s): After ethical approval, a structured questionnaire has been distributed among healthcare professionals who were willing to participate in the study. The questionnaire contained forty questions, which were divided into four sections. Result(s): A total of 126 participants completely filled the questionnaire, including 65 (51.6%) females and 61(48.4%) males. Fatigability is the most common (38.1%) post-COVID clinical manifestation in healthcare professionals. Other common post-COVID clinical manifestations are numbness in the face/ arms/ legs (34.2%), cough (23%), muscle pain (20.6%) and anxiety/depression (20.6%) in order of frequency. Discussion(s): The presence of fatigue, anxiety, cough and hair fall was observed in women healthcare workers up to 2 months even after recovery from mild to moderate disease.Copyright © 2022, Derman Medical Publishing. All rights reserved.

A 3-year analysis of the impact of COVID-19 pandemic on NSTEMI incidence, clinical characteristics, management, and outcomes.

OBJECTIVE: The COVID-19 pandemic has been associated with decreased incidence of acute coronary syndrome with worsened outcomes. Few studies have addressed the effects beyond the initial phases of the pandemic. This study elucidated the incidence, clinical characteristics, management, and outcomes of NSTEMI at a tertiary referral center from sample time periods of 2019-2022. METHODS: This study included consecutive NSTEMI patients from March 14-May 9, 2019-2022. Variables included baseline characteristics, clinical features on arrival, management strategy, time parameters, and adverse outcomes. The primary outcome was defined as death, heart failure requiring diuretics, and/or sustained ventricular arrhythmia. RESULTS: This study comprised 250 patients of whom 181 who were admitted during the COVID-19 outbreak. Baseline characteristics were similar among groups. There was a reduction in door-to-angiography time from 29 h in 2019 to 19 h in 2020 [p = 0.01] and 20 h in 2021 [p = 0.02]. PCI intervention increased from 31.8% in 2019% to 50.0% in 2020 [p = 0.05] and 54.7% in 2021 [p < 0.01]. Median length-of-stay (LOS) was reduced from 3 days in 2019 to 2 days in 2020 [p = 0.03]. There was no significant change in outcomes in COVID-19 cohorts compared to control year. CONCLUSIONS: NSTEMI patients during the first 2 years of the COVID-19 pandemic were associated with reduced door-to-angiography times and increased percutaneous coronary intervention (PCI), and patients in year one were associated with reduced LOS. This study suggests that NSTEMI may be managed more efficiently thus reducing hospital bed utilization and potential costs.

Analyzing Access to Health Facilities by Road Using Unconventional Data Sources

The COVID-19 pandemic has led to an urgent need in emerging economies to quickly identify vulnerable populations that do not live within access of a health facility for testing and vaccination. This access information is critical to prioritize investments in mobile and temporary clinics. To meet this need, the World Bank team sought to develop an open-source methodology that could be quickly and easily implemented by government health departments, regardless of technical and data collection capacity. The team explored use of readily available open-source and licensable data, as well as non-intensive computational methodologies. By bringing together population data from Facebook's Data for Good program, travel-time calculations from Mapbox, road network and point-of-interest data from the OpenStreetMap (OSM), and the World Bank's open-source GOSTNets network routing tools, we created a computational framework that supports efficient and granular analysis of road-based access to health facilities in two pilot locations—Indonesia and the Philippines. Our findings align with observed health trends in these countries and support identification of high-density areas that lack sufficient road access to health facilities. Our framework is easy to replicate, allowing health officials and infrastructure planners to incorporate access analysis in pandemic response and future health access planning. © National Academy of Sciences: Transportation Research Board 2022.

The impact of COVID-19 on GCC equity and debt markets: Evidence from TVP-VAR estimation

COVID-19 has rapidly evolved into a global pandemic and has strongly impacted financial markets of the world, including the Gulf Cooperation Council (GCC) region. Since the outbreak is unprecedented, there is a need to analyze the effects of the disease on volatility spillovers between equity and bond markets. We empirically investigated the impact of the COVID-19 pandemic on the financial equity and debt markets in the GCC region. We used the TVP-VAR dynamic connectedness approach to measure risk transmission in the GCC market. This study investigated the time-varying behavior of GCC equity and conventional and Islamic debt markets using data from 1 January 2019 to 30 August 2021. The results were also validated by performing a DCC-GARCH analysis to check the shock and spillovers among the GCC markets. We found the persistent shock transmitter roles of equity markets to bond and Sukuk markets in the GCC region, and the total dynamic connectedness increased during the first wave of the COVID-19 pandemic. Overall, the significant level of interconnectedness exists within the GCC markets.

Air transportation encounters inflationary headwinds on its recovery from pandemic

Puranik et al discuss air transportation which encounters inflationary headwinds on its recovery from pandemic. A strong and growing global air travel demand, supported by the lifting of air travel restrictions in most countries, fueled the global airline industry's continued recovery this year from the impacts of covid-19. In June, the International Air Transport Association projected a total of 3.8 billion passengers for the year--83% of pre-pandemic levels--and a record high air cargo volume of more than 68 million tons, resulting in a global airline industry loss of $9.7 billion this year down from $42.1 billion in 2021. Only the North America region was expected to achieve profitability, with an estimated $8.8 billion profit. In October, member states of the International Civil Aviation Organization adopted the goal of achieving net-zero carbon emissions by 2050, a target that IATA member airlines had committed to in Oct 2021.

Intensive care unit adaptations in the COVID-19 pandemic: Lessons learned.

The coronavirus disease 2019 pandemic had deleterious effects on the healthcare systems around the world. To increase intensive care units (ICUs) bed capacities, multiple adaptations had to be made to increase surge capacity. In this editorial, we demonstrate the changes made by an ICU of a midwest community hospital in the United States. These changes included moving patients that used to be managed in the ICU to progressive care units, such as patients requiring non-invasive ventilation and high flow nasal cannula, ST-elevation myocardial infarction patients, and post-neurosurgery patients. Additionally, newer tactics were applied to the processes of assessing oxygen supply and demand, patient care rounds, and post-ICU monitoring.

SARS-CoV-2 vaccine-breakthrough infections (VBIs) by Omicron (B.1.1.529) variant and consequences in structural and functional impact (preprint)

We examined the effects of mutations on domains (NID, RBM, and SD2) found at the interfaces of spike domains Omicron B.1.1529, Delta/B.1.1529, Alpha/B.1.1.7, VUM B.1.526, B.1.575.2, and B.1.1214 (formerly VOI Iota). We tested the affinity of Omicron for hACE2 and found that the wild and mutant spike proteins were using atomistic molecular dynamics simulations. According to binding free energies calculated during mutagenesis, hACE2 bound Omicron spike more strongly than SARS-CoV-2 wild strain. T95I, D614G, and E484K are three substitutions that significantly contribute to the RBD, corresponding to hACE2 binding energies and a doubling of Omicron spike proteins' electrostatic potential. Omicron appears to bind hACE2 with greater affinity, increasing its infectivity and transmissibility. The spike virus was designed to strengthen antibody immune evasion through binding while boosting receptor binding by enhancing IgG and IgM antibodies that stimulate human {beta}-cell, as opposed to the wild strain, which has more vital stimulation of both antibodies.

Classification of neurologic outcomes from medical notes using natural language processing.

Neurologic disability level at hospital discharge is an important outcome in many clinical research studies. Outside of clinical trials, neurologic outcomes must typically be extracted by labor intensive manual review of clinical notes in the electronic health record (EHR). To overcome this challenge, we set out to develop a natural language processing (NLP) approach that automatically reads clinical notes to determine neurologic outcomes, to make it possible to conduct larger scale neurologic outcomes studies. We obtained 7314 notes from 3632 patients hospitalized at two large Boston hospitals between January 2012 and June 2020, including discharge summaries (3485), occupational therapy (1472) and physical therapy (2357) notes. Fourteen clinical experts reviewed notes to assign scores on the Glasgow Outcome Scale (GOS) with 4 classes, namely 'good recovery', 'moderate disability', 'severe disability', and 'death' and on the Modified Rankin Scale (mRS), with 7 classes, namely 'no symptoms', 'no significant disability', 'slight disability', 'moderate disability', 'moderately severe disability', 'severe disability', and 'death'. For 428 patients' notes, 2 experts scored the cases generating interrater reliability estimates for GOS and mRS. After preprocessing and extracting features from the notes, we trained a multiclass logistic regression model using LASSO regularization and 5-fold cross validation for hyperparameter tuning. The model performed well on the test set, achieving a micro average area under the receiver operating characteristic and F-score of 0.94 (95% CI 0.93-0.95) and 0.77 (0.75-0.80) for GOS, and 0.90 (0.89-0.91) and 0.59 (0.57-0.62) for mRS, respectively. Our work demonstrates that an NLP algorithm can accurately assign neurologic outcomes based on free text clinical notes. This algorithm increases the scale of research on neurological outcomes that is possible with EHR data.

COVID-19 PNEUMONIA COMPLICATED BY EXACERBATION OF NEW DIAGNOSIS OF MYASTHENIA GRAVIS

SESSION TITLE: COVID-19 Case Report Posters 1 SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: COVID-19 infection with concurrent myasthenia gravis (MG) presents a unique diagnostic challenge for the clinician. We report the case of a patient presenting with respiratory failure secondary to COVID-19 Pneumonia and being diagnosed with MG. CASE PRESENTATION: Patient is a 72-year-old male without any significant medical history presented with progressively worsening shortness of breath, associated dysphagia and fatigue for 1-week duration. Laboratory data and imaging findings were suggestive of COVID-19 pneumonia. Patient's respiratory status deteriorated requiring mechanical ventilation. His oxygenation improved with steroid and anti-viral therapy. However, he was unable to be liberated from the ventilator secondary to neuromuscular weakness. Further work up confirmed MG. Patient was treated with high-dose steroids, pyridostigmine and intravenous immunoglobulin therapy. Patient was unable to be extubated and required a tracheostomy placement. DISCUSSION: Observational studies have suggested the rate of MG exacerbation to be 10-15% in COVID-19 infection. Mortality was found to be significantly higher in these patients compared to patients without MG. Several case reports have also shown exacerbation of previously asymptomatic MG with COVID-19 infection. Studies have indicated underlying MG to be an independent prognostic risk factor in COVID-19 infection. Treatment involves achieving symptomatic improvement with use of pyridostigmine, corticosteroids and long-term steroid sparing agents, in addition to administering usual treatment for COVID-19 infection. CONCLUSIONS: Our patient presents as a case of COVID 19 infection complicated with a possibly induced or previously undiagnosed case of MG complicating the clinical course. During evaluation of patients with respiratory failure secondary to COVID-19 infection, history focused on symptoms that may indicate underlying neuromuscular diseases should be obtained for early diagnosis and proper management. Given the high co-existence, it is important for clinicians to be aware of the association and treatment strategies in such patients. Reference #1: Galassi G, Marchioni A. Myasthenia gravis at the crossroad of COVID-19: focus on immunological and respiratory interplay. Acta Neurol Belg. 2021;121(3):633-642. doi:10.1007/s13760-021-01612-6 Reference #2: Sriwastava S, Tandon M, Kataria S, Daimee M, Sultan S. New onset of ocular myasthenia gravis in a patient with COVID-19: a novel case report and literature review. J Neurol. 2021;268(8):2690-2696. doi:10.1007/s00415-020-10263-1 Reference #3: Rodrigues CL, de Freitas HC, Lima PRO, et al. Myasthenia gravis exacerbation and myasthenic crisis associated with COVID-19: case series and literature review. Neurol Sci. 2022;43(4):2271-2276. doi:10.1007/s10072-021-05823-w DISCLOSURES: No relevant relationships by Asad Chohan No relevant relationships by Saiara Choudhury No relevant relationships by Rahul Dadhwal No relevant relationships by Rene Franco No relevant relationships by Ahsan Syed No relevant relationships by Pahnwat Taweesedt No relevant relationships by Abhay Vakil

Chlorpheniramine Intranasal Spray to Accelerate COVID-19 Clinical Recovery in an Outpatient Setting: The ACCROS Trials (preprint)

Purpose: Our group demonstrated the safety, efficacy, and antiviral effect of intranasally administered Chlorpheniramine Maleate (CPM) for treating coronavirus disease 2019 (COVID-19). Since the nasal cavity is the portal of entry for COVID pathogens, sensory and upper respiratory symptoms (URS) (e.g., cough, ageusia, anosmia, nasal congestion, etc.) are significant symptoms in the course of the disease. Intranasal therapies could alleviate the disease-induced URS faster. This study evaluated the effectiveness and safety of intranasal CPM for treating mild to moderate COVID-19-induced URS in the outpatient setting. Methods: The two-part Accelerating COVID-19 Clinical Recovery in an Outpatient Setting (ACCROS) research study was conducted to collect evidence from a randomized, double-blinded placebo-controlled trial (ACCROS-I). Both parts enrolled patients with mild to moderate COVID-19 confirmed by reverse transcription-polymerase chain reaction. The primary endpoint in ACCROS-I was time to clinical recovery, defined as the change from baseline to day 7 in COVID-19 symptoms reported as the percent change (Δ%) in the daily symptoms score (DSS) and the severity of the disease symptoms using a visual analog scale (VAS), on a scale of 1-10 (10=worst symptoms). COVID-19 patients (n = 101) were recruited and assigned to either a 10-day CPM treatment (n=61) or placebo (PLB) (n=40) in addition to standard of care (SoC). Secondary endpoints included the incidence of hospitalization and the proportion of patients with URS on day 7. ACCROS-II data were collected from medical records of COVID-positive subjects using a standardized form. Cohorts of patients treated with CPM and SoC (CPM+Soc) were compared for the duration of general symptoms and URS. Patient information was collected as part of routine visits and telehealth consultations. Results ACCROS-I: There was a statistically significant difference in the rate of clinical recovery (P<0.05) in Δ%DSS (M -18.8±SEM 7.9%) and Δ%VAS (-8.6±5.1%), such that the CPM group reported fewer symptoms than PLB. The proportion of patients who reported sensory deficits and URS at day 7 was significantly lower (P<0.05) in CPM vs. PLB for ageusia (1.7% vs. 15.0%), cough (16.4% vs. 35.0%) and nasal congestion (8.1%vs.20%). None of the patients required hospitalization. ACCROS-II: There was a statistically significant reduction (P<0.05) in total days reporting URS for general symptoms of COVID-19 in CPM+SoC (5.1 ± 0.1) compared to SoC (11.0 ± 0.2). CPM+SoC users also showed fewer days with cough, anosmia, and ageusia. Persistent anosmia (over 29 days) was found in 3% of the patients on SoC, whereas no persistent anosmia was reported in the CPM+SoC cohort (X2 = 10.18; P<0.001). Conclusion: The result of this two-part study supports the conclusion that intranasal CPM is an antiviral agent that can be administered intranasally to treat COVID-19-induced symptoms effectively. Intranasal CPM accelerates clinical recovery and reduces URS in patients with mild to moderate COVID-19. This study's important implications include individuals returning to daily life faster, reducing community and individual economic burden, and decreasing healthcare utilization. Trial registration: ClinicalTrials.gov.; ID: NCT05449405 ACCROS-I retrospectively registered on 7/13/2022, NCT05520944 ACCROS-R retrospectively registered on 08/27/2022.

Intranasal Xylitol for the Treatment of COVID-19 in the Outpatient Setting: A Pilot Study.

It is well known that acute COVID-19 infection can present with a variety of symptoms, including fever, cough, rhinitis, loss of taste, and the cardinal sign of loss of smell (anosmia). Recently, nasal irrigations with saline and other agents have shown promise for the treatment of COVID-19. Xylitol has been shown to display virucidal effects against SARS-CoV-2. This study aimed to examine the efficacy of xylitol as an adjunct treatment for COVID-19 in an outpatient setting. In a randomized controlled double-blinded fashion, a total of 50 participants (F=30) consented to participate in this study. It was a population of 18 to 65 years of age, with polymerase chain reaction confirmed for SARS-COV-2 by nasopharyngeal swab, less than three days from the start of symptoms. This study's primary endpoint was time to clinical recovery, defined as the change from baseline to end of treatment in COVID-19 symptoms. Outcome variables were the changes in visual analog scale (VAS) and daily symptoms score (DSS) on Days 1-7, 14, and 28 after the initiation of the 14-day treatment. There were no differences between the treatment groups in any demographic and subject characteristics-related variables, including vaccination status. None of the patients were hospitalized, or required emergency visits in addition to no adverse reactions were reported. There were no statistically significant interactions found for VAS (P=0.124), DSS (P=0.448), and sense of smell (P=0.667). The proportion of patients reporting nasal congestion was higher (X2=5.05; P=0.025) in the xylitol (XYL) group (73.1%) vs. the saline (SAL) group (41.7%) on Day 4, and on Day 7 (X2=5.72; P=0.017) XYL group (50.0%) vs. SAL group (17.4%). During Day 28 a total of two patients in the SAL group had anosmia vs. no patients with anosmia in the XYL group, although this difference did not reach statistical significance (X2=5.72; P=0.133). Results demonstrate that both xylitol and saline were equally effective in decreasing the time of symptom resolution and preventing hospitalizations, yet, persistent anosmia was only seen in the SAL group. Intranasal xylitol might play a pivotal role in preventing persistent olfactory abnormalities in post-COVID-19 patients.

Previous SARS-CoV-2 infection or a third dose of vaccine elicited cross-variant neutralising antibodies in vaccinated solid-organ transplant recipients.

Objectives: The SARS-CoV-2 pandemic poses a great threat to global health, particularly in solid organ transplant recipients (SOTRs). A 3-dose mRNA vaccination protocol has been implemented for the majority of SOTRs, yet their immune responses are less effective compared to healthy controls (HCs). Methods: We analyzed the humoral immune responses against the vaccine strain and variants of concern (VOC), including the highly mutated-omicron variant in 113 SOTRs, of whom 44 had recovered from COVID-19 (recovered-SOTRs) and 69 had not contracted the virus (COVID-naïve). In addition, 30 HCs, 8 of whom had recovered from COVID-19, were also studied. Results: Here, we report that three doses of the mRNA vaccine had only a modest effect in eliciting anti-viral antibodies against all viral strains in the fully vaccinated COVID-naive SOTRs (n = 47). Only 34.0% of this group of patients demonstrated both detectable anti-RBD IgG with neutralization activities against alpha, beta, and delta variants, and only 8.5% of them showed additional omicron neutralizing capacities. In contrast, 79.5% of the recovered-SOTRs who received two doses of vaccine demonstrated both higher anti-RBD IgG levels and neutralizing activities against all VOC, including omicron. Conclusion: These findings illustrate a significant impact of previous infection on the development of anti-SARS-CoV-2 immune responses in vaccinated SOTRs and highlight the need for alternative strategies to protect a subset of a lesser-vaccine responsive population.