Platelet Activation and Cytokine Release of Interleukin-8 and Interferon-Gamma-Induced Protein 10 after ChAdOx1 nCoV-19 Coronavirus Vaccine Injection.

Coronavirus disease 2019 (COVID-19) vaccines are associated with serious thromboembolic or thrombocytopenic events including vaccine-induced immune thrombocytopenia and thrombosis and immune thrombocytopenia, particularly AZD1222/ChAdOx1. According to the proposed mechanism, COVID-19 vaccines stimulate inflammation and platelet activation. In this study, we analyzed the role of AZD1222/ChAdOx1 vaccines in the activation of platelets and the release of anti-PF4 antibodies and inflammatory cytokines in a cohort of healthy donors without vaccine-induced immune thrombotic thrombocytopenia (VITT). Forty-eight healthy volunteers were enrolled in this study. Blood samples were collected from peripheral blood at three time points: before vaccination and 1 and 7 days after vaccination. Compared with the prevaccination data, a decrease in the leukocyte and platelet counts was observed 1 day after vaccination, which recovered 7 days after injection. The percentage of activated GPIIb/IIIa complex (PAC-1) under high ADP or thrombin receptor-activating peptide stimulation increased 1 day after vaccination. Furthermore, interluekin-8 (IL-8) and interferon-gamma-induced protein 10 (IP-10) increased significantly. Additionally, platelet activation and inflammation, with the release of cytokines, were observed; however, none of the individuals developed VITT. Mild thrombocytopenia with platelet activation and inflammation with an elevation of IL-8 and IP-10 were observed after AZ vaccination.

Hepatitis of unknown etiology in children: Current evidence and association.

Two years after the coronavirus disease 2019 (COVID-19) pandemic, acute hepatitis of unknown etiology in children (AHUCD) began to be reported worldwide. The novel coronavirus and adenovirus were found in pathogen and antibody tests in AHUCD cases reported by the World Health Organization. Children are not exposed to the viruses that children are generally exposed to owing to COVID-19 infection preventive measures such as isolation and wearing masks; therefore, some researchers have speculated that this disease is related to reduced exposure to pathogens. Some scientists have also speculated that the disease is related to liver injury and adenoviral hepatitis, which are the sequelae of COVID-19. Some evidence also suggests a weak association between the disease and COVID-19 vaccination. Therefore, further research and investigation of the pathogenesis, preventive measures, and early treatment of hepatitis of unknown etiology are required. This study aimed to synthesize available evidence to further elucidate this disease in order to treat and prevent it effectively.

Role of time perspectives and self-control on well-being and ill-being during the COVID-19 pandemic: A multiple mediation model (preprint)

Background A growing body of evidence indicates that the outbreak of COVID-19 has had a significant influence on individuals’ cognition, emotion, and psychological health. This study aims to explore the effect of the association between time perspectives and self-control on the well-being and ill-being among college students in China during the COVID-19 pandemic.Methods We conducted an online survey involving 1,924 participants in mainland China during the outbreak of COVID-19. A series of self-rating questionnaires measuring the perceived impact of COVID-19, time perspectives, self-control, as well as the statuses of well-being and ill-being were administered. Multiple indirect effects of time perspectives and self-control on well-being and ill-being were analysed through structural equation modelling.Results The present-hedonistic time perspective (an orientation on immediate impulses of pleasure) meditated the effects of perceived impacts on both well-being and ill-being, and the future time perspective (considering the outcomes of actions and decisions) mediated the effects on well-being. Moreover, the mediating effects were further mediated by self-control. Specifically, the impact of the future time perspective on ill-being was fully mediated by self-control (β = 0.01, p < 0.01).Conclusion Based on the results, it is evident that the present-hedonistic time perspective, the future time perspective, and self-control are related to higher levels of well-being and lower levels of ill-being, thereby providing further insight into the theoretical framework of time perspectives during the COVID-19 pandemic. Additionally, our findings provide practical implications for psychological interventions during the on-going COVID-19 pandemic, focusing on the effects of time perspectives and self-control on the well-being and ill-being of different individuals.

Metabolic Landscape of Bronchoalveolar Lavage Fluid in Coronavirus Disease 2019 at Single Cell Resolution

Abnormal function of immune cells is one of the key mechanisms leading to severe clinical symptoms in coronavirus disease 2019 patients, and metabolic pathways can destroy the function of the immune system by affecting innate and adaptive immune responses. However, the metabolic characteristics of the immune cells of the SARS-CoV-2 infected organs in situ remaining elusive. We reanalyzed the metabolic-related gene profiles in single-cell RNA sequencing data, drew the metabolic landscape in bronchoalveolar lavage fluid immune cells, and elucidated the metabolic remodeling mechanism that might lead to the progression of COVID-19 and the cytokine storm. Enhanced glycolysis is the most important common metabolic feature of all immune cells in COVID-19 patients. CCL2+ T cells, Group 2 macrophages with high SPP1 expression and myeloid dendritic cells are among the main contributors to the cytokine storm produced by infected lung tissue. Two metabolic analysis methods, including Compass, showed that glycolysis, fatty acid metabolism, bile acid synthesis and purine and pyrimidine metabolism levels of CCL2+ T cells, Group 2 macrophages and myeloid dendritic cells were upregulated and correlated with cytokine storms of COVID-19 patients. This might be the key metabolic regulatory factor for immune cells to produce large quantities of cytokines.

New presentations and exacerbations of immune thrombocytopenia after coronavirus disease 2019 vaccinations: the Taiwan experience.

Immune thrombocytopenia (ITP) is a condition that is distinct from thrombosis with thrombocytopenia syndrome (TTS) that may also occur after coronavirus disease 2019 (COVID-19) vaccinations. Previous reports revealed an increased ITP incidence after ChAdOx1, a vaccine for COVID-19. Our study aimed to highlight the key features of ITP after COVID-19 vaccination. From April to October 2021, we collected data on 23 patients, including nine men and 14 women, with ITP from five hospitals across Taiwan who received either the ChAdOx1 or mRNA-1273 vaccine before development or exacerbation of ITP. Our findings revealed that both ChAdOx1 and mRNA-1273 vaccines were associated with ITP. Many patients responded well to steroids and immune suppressants, which may also suggest that the nature of thrombocytopenia is more like ITP rather than TTS. Lack of thrombosis, low D-dimer level, and negative anti-PF4 result could help to exclude TTS, which is also a rare but a far more lethal condition.

Omicron: a chimera of two early SARS-CoV-2 lineages (preprint)

The current global epidemiology of COVID-19 is now characterized by the emergence and rapid spread of the SARS-CoV-2 Omicron variant on a global scale 1,2 . Despite the variant’s prompt predominance, there remain knowledge gaps in its origin and evolution history 3–6 . Here, we show that Omicron lineage SARS-CoV-2 is characterized by the feature of chimera. It was generated by genomic recombination of two early PANGO lineages of SARS-CoV-2. In the recombination event, strains with medium or high circulating intensity like SARS-CoV-2/human/USA/COR-21-434196/2021 belonging to PANGO lineage BA.1 provided the fundamental genome and served as the major parents, while the rare lineage strains like SARS-CoV-2/human/IRN/Ir-3/2019 belonging to B.35, as the minor parents, hybridized their genomic fractions into the major genomes at position 21593-23118nt. This recombination event results in 22 amino acid residue substitutions for the variant of Omicron, including 16 in the pivotal RBD of the spike protein. These substitutions have led to some subtle variations in the spatial structure and the affinity to hACE2 receptor of the spike protein 7,8 , thereby raising concerns about the effectiveness of available vaccines and antibody therapeutics 9–12 . The global spread and explosive growth of the SARS-CoV-2 in human population increase opportunities for future recombination 13–15 .

Efficacy of COVID-19 Treatments: A Bayesian Network Meta-Analysis of Randomized Controlled Trials.

Background: We provided a comprehensive evaluation of efficacy of available treatments for coronavirus disease 2019 (COVID-19). Methods: We searched for candidate COVID-19 studies in WHO COVID-19 Global Research Database up to August 19, 2021. Randomized controlled trials for suspected or confirmed COVID-19 patients published on peer-reviewed journals were included, regardless of demographic characteristics. Outcome measures included mortality, mechanical ventilation, hospital discharge and viral clearance. Bayesian network meta-analysis with fixed effects was conducted to estimate the effect sizes using posterior means and 95% equal-tailed credible intervals (CrIs). Odds ratio (OR) was used as the summary measure for treatment effect. Bayesian hierarchical models were used to estimate effect sizes of treatments grouped by the treatment classifications. Results: We identified 222 eligible studies with a total of 102,950 patients. Compared with the standard of care, imatinib, intravenous immunoglobulin and tocilizumab led to lower risk of death; baricitinib plus remdesivir, colchicine, dexamethasone, recombinant human granulocyte colony stimulating factor and tocilizumab indicated lower occurrence of mechanical ventilation; tofacitinib, sarilumab, remdesivir, tocilizumab and baricitinib plus remdesivir increased the hospital discharge rate; convalescent plasma, ivermectin, ivermectin plus doxycycline, hydroxychloroquine, nitazoxanide and proxalutamide resulted in better viral clearance. From the treatment class level, we found that the use of antineoplastic agents was associated with fewer mortality cases, immunostimulants could reduce the risk of mechanical ventilation and immunosuppressants led to higher discharge rates. Conclusions: This network meta-analysis identified superiority of several COVID-19 treatments over the standard of care in terms of mortality, mechanical ventilation, hospital discharge and viral clearance. Tocilizumab showed its superiority compared with SOC on preventing severe outcomes such as death and mechanical ventilation as well as increasing the discharge rate, which might be an appropriate treatment for patients with severe or mild/moderate illness. We also found the clinical efficacy of antineoplastic agents, immunostimulants and immunosuppressants with respect to the endpoints of mortality, mechanical ventilation and discharge, which provides valuable information for the discovery of potential COVID-19 treatments.

COVID-19 or treatment associated immunosuppression may trigger hepatitis B virus reactivation: A case report.

BACKGROUND: Since the initial recognition of coronavirus disease 2019 (COVID-19) in Wuhan, this infectious disease has spread to most areas of the world. The pathogenesis of COVID-19 is yet unclear. Hepatitis B virus (HBV) reactivation occurring in COVID-19 patients has not yet been reported. CASE SUMMARY: A 45-year-old hepatitis B man with long-term use of adefovir dipivoxil and entecavir for antiviral therapy had HBV reactivation after being treated with methylprednisolone for COVID-19 for 6 d. CONCLUSION: COVID-19 or treatment associated immunosuppression may trigger HBV reactivation.

Differential Psychological Factors Associated With Unnecessary Dental Avoidance and Attendance Behavior During the Early COVID-19 Epidemic.

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 is challenging the dental community to an unprecedented degree. Knowledge of the increased risk of infection in dental settings has been disseminated to the public and guidelines have been formulated to assist dental attendance decision-making. However, dental attendance behaviors incompatible with treatment need is not uncommon in clinical settings. Important gaps remain in the knowledge about how psychological factors are affecting dental attendance behaviors during the COVID-19 epidemic. In this cross-sectional study, a questionnaire survey was performed during February and March 2020. A total of 342 and 294 dental patients who attended and avoided dental visits, respectively, were included. The participants were classified into four groups based on dental attendance behavior and emergent/urgent dental treatment need. Bivariate analysis was performed to investigate factors associated with dental attendance. Multivariable logistic regression based on principal component scores was performed to identify major psychological constructs associated with unnecessary dental avoidance and attendance. Among all the factors explored, inability to wear masks during dental treatment (P < 0.001; effect size: 0.32) was most closely associated with the overall pattern of dental attendance among participants. Multivariable regression suggested that unnecessary dental avoidance was associated with perceived risk of infection in general and in dental settings (odds ratio [95% CI]: 0.62 [0.53, 0.72]; p < 0.001), perceived impact of COVID-19 and dental problems on general health (0.79 [0.65, 0.97]; 0.021), and personal traits such as trust and anxiety (0.77 [0.61, 0.98]; 0.038). Unnecessary dental attendance was associated with optimism toward the epidemic (1.68 [1.42, 2.01]; <0.001) and trust (1.39 [1.13, 1.74]; 0.002). Multidisciplinary efforts involving dental and medical professionals as well as psychologists are warranted to promote more widespread adoption, among the general public, of dental attendance behaviors compatible with dental treatment need during the COVID-19 epidemic.

Serum levels of the IgA isotype switch factor TGF-ß1 are elevated in patients with COVID-19.

We previously observed enhanced immunoglobulin A (IgA) responses in severe COVID-19, which might confer damaging effects. Given the important role of IgA in immune and inflammatory responses, the aim of this study was to investigate the dynamic response of the IgA isotype switch factor TGF-ß1 in COVID-19 patients. We observed, in a total of 153 COVID-19 patients, that the serum levels of TGF-ß1 were increased significantly at the early and middle stages of COVID-19, and correlated with the levels of SARS-CoV-2-specific IgA, as well as with the APACHE II score in patients with severe disease. In view of the genetic association of the TGF-ß1 activator THBS3 with severe COVID-19 identified by the COVID-19 Host Genetics Initiative, this study suggests TGF-ß1 may play a key role in COVID-19.

Faculty attendance and perception of virtual educational conferences in pediatric emergency medicine during the COVID-19 pandemic (preprint)

Background: Attendance of in-person didactic conferences is a key component of graduate medical education and training in pediatric emergency medicine. Faculty participation in didactic conferences is important, although challenges to attendance exist. The SARS CoV-2 global pandemic disrupted in-person medical education and forced migration to virtual learning. Our goal was to describe how the change to virtual learning affected pediatric emergency medicine conference attendance by faculty in the division at a large academic medical center. Participants were also surveyed to provide insight into perceptions of virtual conferences. Methods: Faculty attendance of in-person conferences (fellow conference from 2017–2020, resident conference from 2019–2020) was compared to attendance of virtual conferences (April - June 2020). Conference participants were surveyed to assess attitudes towards the virtual format. Descriptive statistics were used to describe variables. Results: The transition to virtual learning increased pediatric emergency medicine faculty attendance of all conferences. Fellows conference attendance increased from 11.8–49.2% of available faculty (3.3 to 13.8 out of 28) (95% CI -14.0 to -9.09 p Conclusions: Virtual conferences increased faculty attendance in both fellow and resident pediatric emergency medicine educational conferences. It was well received by participants, and most would like to continue virtual learning in the future.

When there is a will there is a way: The role of proactive personality in combating COVID-19.

The global COVID-19 pandemic has disrupted personal and work lives and created great uncertainty and stress, especially for frontline health care professionals like doctors and nurses who risk personal health while facing increased workloads and new COVID-related tasks. People can passively respond to this disruption, or they can be more active and choose to shape the conditions surrounding their work during the crisis. We designed a multiwave, multisource study examining whether a proactive orientation is a key resource for frontline health care professionals in the COVID-19 pandemic. Drawing from proactive and conservation of resources theories, we studied a sample of 408 doctors and nurses at a COVID-19 hospital in the locked-down area surrounding Wuhan City, China during the first wave of the virus. Our aim is to examine how personal agency contributes to health care professionals' performance and well-being when combating COVID-19. Proactive personality as a dispositional resource was associated with higher levels of perceived strengths use, a job-related motivational resource. This effect was jointly moderated by routine disruption and perceived organizational support. Proactive personality was indirectly associated with performance and two indicators of well-being (resilience and thriving) through perceived strengths use. More frequent physical exposure to the virus magnified the effects of perceived strengths use on an archival indicator of performance during the first wave of the pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

What Protects Us Against the COVID-19 Threat? Cultural Tightness Matters (preprint)

Background: The only previous studies that formulated a theoretical model of epidemics for psychological response relative to cultural perspectives have focused on the role of individualism–collectivism and have omitted analysis of tightness–looseness. This study explored the role of cultural tightness in relation to psychological disorders during the outbreak of the COVID-19 pandemic.Methods: We recruited 1827 Chinese adolescents (Mage = 17.78 ± 1.94 years, 55.5% female) to participate a cross-sectional survey. Participants completed a series of questionnaires, including the scales of cultural tightness, risk perception of COVID-19 pandemic, perceived protection efficacy, anxiety and depression. A latent moderated structural equations model was used to analyse the mediating and moderating effects of risk perception regarding COVID-19, cultural tightness and perceived protection efficacy on psychological disorders. Results: The results showed that greater risk perception of COVID-19 predicted greater psychological disorders, however cultural tightness moderated this positive relationship. The increase in psychological disorders with risk perception regarding COVID-19 was less pronounced among people who lived in tighter cultural areas. In addition, this moderating effect of cultural tightness was further mediated by perceived protection efficacy; that is, tight culture protects against psychological disorders by enhancing perceived protection efficacy. Conclusion: This study enriched the theoretical framework of cultural tightness and indicated its importance in the field of mental health and health policies. It also emphasized the importance of tight culture as a protective factor against psychological disorders in case of COVID-19 outbreaks, providing valuable practical insight into psychological prevention for COVID-19 outbreaks. 

Prevalence and related risk factors of psychotic symptoms among inpatients infected with COVID-19 during the second wave pandemic (preprint)

Background Possibility of psychotic symptoms and related risk factors among the normal person and infected patients during the outbreak of COVID-19 has been widely investigated in previous studies. With the arrival of the second wave of the epidemic in many countries around the word, the accordingly mental health outcomes were unclear yet, especially the mental health outcomes among infected patients. It aims to explore the prevalence of and related risk factors associated with psychotic symptoms in COVID-19 infected inpatients during the second wave.Method: A cross-sectional survey was conducted in five isolated wards of a designated hospital in Beijing, China, from 1 July to 15 July, 2020. The Mini-International Neuropsychiatric Interview (M.I.N.I) was conducted to assess the psychiatric disorders, and a serious of scales was used to measure self-reported psychotic symptoms and psychosomatic factors. Multivariate regression analysis was used to analyze the risk factors associated with psychotic symptoms.Results Among 199 infected participants, the prevalence of generalized anxiety symptoms is 51.3%, of depressive symptoms 41.2%, of PTSD symptoms 33.6%. Loneliness, hope, coping strategies, history of mental disorders were shared risk or protective factors across several psychotic symptoms. Perceived impact by COVID-19 is the specific risk factor associated with state anxiety symptoms.Conclusions The prevalence of symptoms of depression, anxiety and PTSS/PTSD is high among infected inpatients during the second wave of pandemic in Beijing. Clinical doctors must realize that infected inpatients during the second wave of pandemic are likely to suffer from depressive disorder, anxiety disorders and PTSS/PTSD, as well as some neuropsychiatric syndromes. Specific mental health care is urgently needed to help inpatients cope with the virus during the second wave of pandemic.

Accumulated Clinical Experiences from Successful Treatment of 1377 Severe and Critically Ill COVID-19 Cases.

In late December 2019, COVID-19 was firstly recognized in Wuhan, China and spread rapidly to all of the provinces of China. The West Campus of Wuhan Union Hospital, the designated hospital to admit and treat the severe and critically ill COVID-19 cases, has treated a large number of such patients with great success and obtained lots of valuable experiences based on the Chinese guideline (V7.0). To standardize and share the treatment procedures of severe and critically ill cases, Wuhan Union Hospital has established a working group and formulated an operational recommendation, including the monitoring, early warning indicators, and several treatment principles for severe and critically ill cases. The treatment experiences may provide some constructive suggestions for treating the severe and critically ill COVID-19 cases all over the world.