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2.
Swiss Medical Weekly ; 152:11S-11S, 2022.
Article in English | Web of Science | ID: covidwho-2169134
3.
Open Access Macedonian Journal of Medical Sciences ; 10:1698-1705, 2022.
Article in English | EMBASE | ID: covidwho-2066674

ABSTRACT

BACKGROUND: The rapid worldwide spread of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) or COVID-19 pandemic from its epicenter;Wuhan was first reported in December 2019. Egypt reported its first COVID-19 case on February 14, 2020. Thereafter, Egypt scaled-up preventive measures, with a partial lockdown starting on March 25. Several therapeutic agents along with convalescent plasma transfusion (CPT) are under investigation and data from CPTs have been receiving a lot of attention, after Emergency approvals from the Food and Drug Administration suggesting that it may provide a clinical effect in the treatment of SARS-COV-2. IMPORTANCE: Early and effective treatment of COVID-19 is vital for control of SARS-CoV-2 infection. METHODS: Designs: An interventional, single-arm, and non-randomized clinical trial conducted in Egypt from April 15 to July 21, 2020. Settings: This was a multi-center study conducted in three hospitals in Egypt. Participants: A total of 94 COVID-19 laboratory-confirmed patients using quantitative real-time polymerase chain reaction were enrolled in the study. Intervention: All patients were administered with two plasma units (each unit is 200 cc). The volume of donated plasma was 800 cc. Main Outcome and measures: Primary measure was the degree of clinical improvement among the COVID-19 patients who received CPT within 7 days. RESULTS: A total of 94 patients were enrolled who received CPT either within 7 days or after 7 days of hospitalization. 82 were severely ill and 12 were critically ill. The average age remained 58 years (±standard deviation 15.1 years). Male were 69% and 49% patients got cured while 51% died with case fatality rate 51%. Seventy-five percent deaths were above 45 years of age. The symptoms were dyspnea (55%), fever (52%), cough (46%), and loss of taste and smell (21%), and cyanosis (15%). The most common co-morbidities among the <40 years remained diabetes mellitus (21%) and asthma (14%). Among 40–60 years hypertension (56%), diabetes mellitus (39%) and among >60 years age group hypertension (57%), and chronic heart disease (24%) were reported. CPT within 7 days remained significant as compared with the CPT after 7 days with the number of days to cure (p=0.007) and ICU stay (p = 0.008) among severely ill cured cases. CONCLUSIONS: Among patients with COVID-19 and severe or critical illness, the use of CPT along with routine standard therapy resulted in a statistically significant improvement when administered within seven days of hospital admission. However, plasma transfusion, irrespective of days to transfusion may not help treat critically ill patients. The overall mean time to cure in severely ill patients was 15 days if CPT provided within 7 days with 65% cure rate. TRIAL REGISTRATION: Clinical Intervention identifier: MOHP_COVID-19_Ver1.1 registered April 2020.

4.
Swiss Medical Weekly ; 152:14S, 2022.
Article in English | EMBASE | ID: covidwho-2040956

ABSTRACT

Background: The highly contagious SARS-CoV-2 is mainly transmitted by respiratory droplets and aerosols. Consequently, people are required to wear masks and maintain a social distance to avoid spreading of the virus. Despite the success of the commercially available vaccines, the virus is still uncontained globally. Given the tropism of SARS-CoV-2, a mucosal immune reaction would help to reduce viral shedding and transmission locally. Only seven out of hundreds of ongoing clinical trials are testing the intranasal delivery of a vaccine against COVID-19. Methods: In the current study, we evaluated the immunogenicity of a traditional vaccine platform based on virus-like particles (VLPs) displaying RBD of SARS-CoV-2 for intranasal administration in a murine model. The candidate vaccine platform, CuMVTT -RBD, has been optimized to incorporate a universal T helper cell epitope derived from tetanus-toxin and is self-adjuvanted with TLR7/8 ligands. Results: CuMVTT-RBD vaccine elicited a strong systemic RBD- and spike- IgG and IgA antibodies of high avidity. Local immune response was assessed and our results demonstrate a strong mucosal antibody and plasma cell production in lung tissue. Furthermore, the induced systemic antibodies could efficiently recognize and neutralize different variants of concern (VOCs) of mutated SARS-CoV-2 RBDs. Conclusion: Our data demonstrate that intranasal administration of CuMVTT-RBD induces a protective systemic and local specific antibody response against SARS-CoV-2 and its VOCs.

5.
Swiss Medical Weekly ; 152:11S, 2022.
Article in English | EMBASE | ID: covidwho-2040918

ABSTRACT

Introduction: Vaccines need to be rationally designed to be delivered to the immune system for maximizing induction of dynamic immune responses. Virus-like nanoparticles (VLPs) are ideal platforms for such 3D vaccines. Coronaviruses have recently gained a lot of attention, due to the ongoing pandemic caused by SARS-CoV-2 and previous endemics by MERS-CoV. Methods: We have provided proof of concepts in murine models for effective development of VLP-based vaccines against MERS-CoV and SASR-CoV-2. We have used chemical conjugation or genetic fusion techniques to display receptor-binding domain or motif on our immunologically optimized (CuMVTT -VLPs). These VLPs incorporate a tetanus toxin epitope and ssRNA, TLR7/8 ligands. The vaccines were tested in murine models. Results: The vaccines are stable for more than a year at 4°C and highly scalable. Vaccination using subcutaneous or intranasal routes are feasible with nanoparticles. We demonstrated that these vaccines are highly immunogenic in mice as well as rabbits and can induce high avidity antibodies compared to convalescent human sera. Furthermore, the induced antibodies are cross-reactive with different VoCs (in case of SARS-CoV-2). The longevity of the induced immune response lasted longer than 120 days. Conclusion: Collectively, we show that VLP-based vaccines can efficiently induce high specific anti-RBD and spike antibodies that effectively neutralize different Coronaviruses and their VoCs. As Coronaviruses represent a continuous global threat to human health, it seems rational to further develop these vaccines.

6.
J Am Coll Surg ; 235(2): 195-209, 2022 08 01.
Article in English | MEDLINE | ID: covidwho-2001542

ABSTRACT

BACKGROUND: A previous survey documented the severe disruption of the coronavirus disease 2019 pandemic on surgical education and trainee well-being during the initial surge and systemic lockdowns. Herein, we report the results of a follow-up survey inclusive of the 2020 to 2021 academic year. STUDY DESIGN: A survey was distributed to education leaders across all surgical specialties in summer 2021. We compared the proportion of participants reporting severe disruption in key areas with those of the spring 2020 survey. Aggregated differences by year were assessed using chi-square analysis. RESULTS: In 2021, severe disruption of education programs was reported by 14% compared with 32% in 2020 (p < 0.0001). Severe reductions in nonemergency surgery were reported by 38% compared with 87% of respondents in 2020. Severe disruption of expected progression of surgical trainee autonomy by rank also significantly decreased to 5% to 8% in 2021 from 15% to 23% in 2020 among respondent programs (p < 0.001). In 2021 clinical remediation was reported for postgraduate year 1 to 2 and postgraduate year 3 to 4, typically through revised rotations (19% and 26%) and additional use of simulation (20% and 19%) maintaining trainee promotion and job placement. In 2021, surgical trainees' physical safety and health were reported as less severely impacted compared with 2020; however, negative effects of isolation (77%), burnout (75%), and the severe impact on emotional well-being (17%) were prevalent. CONCLUSIONS: One year after the initial coronavirus disease 2019 outbreak, clinical training and surgical trainee health were less negatively impacted. Disruption of emotional well-being remained high. Future needs include better objective measures of clinical competence beyond case numbers and the implementation of novel programs to promote surgical trainee health and well-being.


Subject(s)
COVID-19 , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control , Education, Medical, Graduate/methods , Follow-Up Studies , Humans , Pandemics/prevention & control , Surveys and Questionnaires
7.
Ann Med Surg (Lond) ; 79: 103973, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1885599

ABSTRACT

Background: COVID-19, which is caused by the corona virus 2 that causes severe acute respiratory syndrome, causes a respiratory and systemic illness that in 10-15% of patients escalates to a severe form of pneumonia. Thrombocytopenia is frequent in patients with COVID-19. We aimed to evaluate the association between thrombocytopenia and the severity of COVID-19 infection in hospitalized patients. Methods: A cross-sectional study was done on 800 Egyptian patients with confirmed covid-19 infection. They were divided into Group I (Mild): 200 symptomatic patients meeting the case definition for COVID-19 without radiological evidence of pneumonia or hypoxia. Group II (Moderate): 200 patients with clinical signs of non-severe pneumonia and radiological evidence of pneumonia. Group III (Severe): 200 patients with clinical signs of pneumonia plus: respiratory or lung dysfunction. Group IV: 200 critically ill patient in ICU: Acute respiratory distress syndrome (ARDS).Results: there was a highly statistically significant difference between the studied groups regarding thrombocytopenia (p < 0.001). Thrombocytopenia was statistically higher in severe and critically ill patients. In addition, a statistically significant difference found in outcome among the studied groups (p < 0.05) {critically ill (40%), severe (17.5%)}. The most common cause of death was respiratory failure, which occurred in 28 severe patients (80%) and 65 critically ill patients (81.25%), followed by hemorrhage due to thrombocytopenia, which occurred in 7 severe patients (20%) and 15 critically ill patients, respectively (18.75%). Conclusion: The Platelet count is a straightforward, inexpensive, as well as easily available laboratory parameter that is frequently linked to severe covid-19 infection and a significant death risk.

8.
Telkomnika (Telecommunication Computing Electronics and Control) ; 20(1):201-211, 2022.
Article in English | Scopus | ID: covidwho-1753982

ABSTRACT

E-learning allows the students to access, repeat and use the scientific materials wherever and whenever the users want. Both academics and learners are the leading and essential actors in the process of the learning process. Moreover, the acceptance of a technology is the positive react for users by using such technology. Due to the COVID-19 pandemic, e-learning has become mandatory over the world, thus, there is a necessity to investigate the determinants of e-learning adoption in higher education institutions (HEIs) in Iraq. Consequently, this paper aims to investigate elearning adoption and identify the determinants of e-learning in HEIs. An instrument was developed with eight dimensions based on technology organization and environmental (TOE) elements. The sample selection was of 580 students and 130 university lecturers who spread over several colleges. A clustering sampling method was used in the sampling selection process. Some hypotheses were proposed and tested via the paired T-test tool. To evaluate the relationship between the TOE variables and e-learning adoption, a regression analysis was carried out. The study findings classified into two categories, first, it helps to determine to what extent e-learning be adopted. Second, it provides meaningful guidance for higher education institutions that should follow as a pre-requested before adopting e-learning. © 2022. All Rights Reserved.

11.
Swiss Medical Weekly ; 151(SUPPL 251):18S, 2021.
Article in English | EMBASE | ID: covidwho-1406956

ABSTRACT

MERS-CoV continues to cause human outbreaks, so far in 27 countries worldwide following the first registered epidemic in Saudi Arabia in 2012. In this study, we produced a nanovaccine based on virus-like particles (VLPs). VLPs are safe as they lack any replication-competent genetic material, and are used since many years against hepatitis B virus (HBV), hepatitis E virus (HEV) and human papilloma virus (HPV). In order to produce a vaccine that is readily upscalable, we genetically fused the receptor-binding motif (RBM) of MERS-CoV Spike protein into cucumber- mosaic virus-like particles. The employed CuMVTT-VLPs represent a new immunologically optimized vaccine platform incorporating a universal T cell epitope derived from tetanus toxin (TT). The resultant vaccine (mCuMVTT-MERS) consists of unmodified wild type monomers and genetically modified monomers displaying RBM, both co-assemble in a prokaryotic expression system. mCuMVTT-MERS vaccine is self-adjuvanted with ssRNA, a TLR7/8 ligand which is spontaneously packaged during the expression process in E. coli. The ability of the engineered vaccine to bind to MERS-CoV receptor DPP4 was tested in a competitive ELISA. To test the safety and immunogenicity of mCuMVTT-MERS Balb/cOlaHsd mice were primed with 100ug VLPs and boosted on day 28. The developed vaccine induced high anti-RBD and anti-Spike antibodies in a murine model, showing high binding avidity and the ability to completely neutralize MERS-CoV/EMC/2012 isolate, demonstrating the protective potential of the vaccine candidate in dromedaries and humans.

12.
Am J Surg ; 223(2): 395-403, 2022 02.
Article in English | MEDLINE | ID: covidwho-1316373

ABSTRACT

BACKGROUND: The time course and longitudinal impact of the COVID -19 pandemic on surgical education(SE) and learner well-being (LWB)is unknown. MATERIAL AND METHODS: Check-in surveys were distributed to Surgery Program Directors and Department Chairs, including general surgery and surgical specialties, in the summer and winter of 2020 and compared to a survey from spring 2020. Statistical associations for items with self-reported ACGME Stage and the survey period were assessed using categorical analysis. RESULTS: Stage 3 institutions were reported in spring (30%), summer (4%) [p < 0.0001] and increased in the winter (18%). Severe disruption (SD) was stage dependent (Stage 3; 45% (83/184) vs. Stages 1 and 2; 26% (206/801)[p < 0.0001]). This lessened in the winter (23%) vs. spring (32%) p = 0.02. LWB severe disruption was similar in spring 27%, summer 22%, winter 25% and was associated with Stage 3. CONCLUSIONS: Steps taken during the pandemic reduced SD but did not improve LWB. Systemic efforts are needed to protect learners and combat isolation pervasive in a pandemic.


Subject(s)
COVID-19/epidemiology , Communicable Disease Control/standards , Education, Medical/statistics & numerical data , Pandemics/prevention & control , Specialties, Surgical/education , COVID-19/prevention & control , COVID-19/psychology , COVID-19/transmission , Education, Medical/organization & administration , Education, Medical/standards , Humans , Learning , Specialties, Surgical/statistics & numerical data , Surveys and Questionnaires/statistics & numerical data , United States/epidemiology
13.
Topics in Antiviral Medicine ; 29(1):29-30, 2021.
Article in English | EMBASE | ID: covidwho-1250208

ABSTRACT

Background: A disruption of the crosstalk between gut and lung has been implicated as a driver of severity during several respiratory-related diseases. Lung injury causes systemic inflammation, which disrupts gut barrier integrity, increasing the permeability to gut microbes and their products. This exacerbates inflammation, resulting in positive feedback. We applied a multi-omic systems biology approach to investigate the potential link between loss of gut barrier integrity and Coronavirus disease 2019 (COVID-19) severity. Methods: We analyzed plasma samples from age and gender-matched COVID-19 patients (n=60) with varying disease severity (mild, moderate, and severe) and 20 SARS-CoV2 negative controls. We measured markers and drivers of tight junction permeability and microbial translocation using ELISA;inflammation and immune activation markers using ELISA and multiplex cytokine arrays;untargeted metabolomic and lipidomic analyses using mass spectrometry;and plasma glycomes using capillary electrophoresis and lectin microarray. False discovery rate (FDR) was calculated to account for multiple comparisons. Results: Our data indicate, first, that severe COVID-19 is associated with a dramatic increase in the level of zonulin (FDR<0.00001), the only known physiological driver of intestinal tight junction permeability. This increased permeability associated with translocation of both bacterial (LPS binding protein (LBP) levels) and fungal (β-glucan levels) products into blood (FDR<0.01). The degree of intestinal permeability and microbial translocation strongly correlated with increased systemic inflammation (correlations with IL-6 and other inflammatory cytokines and markers) (FDR>0.05). Second, levels of metabolomic and lipidomic markers of gut and gut microbiota functionality including citrulline (a marker of healthy gut;decreased), succinic acid, and tryptophan catabolism metabolites (markers of microbial dysbiosis;increased) were disrupted during severe COVID-19 (FDR<0.05). Finally, the gut microbiome is known to release enzymes that degrade plasma glycans, which regulate inflammation and complement activation. Indeed, severe COVID-19 was associated with loss of the anti-complement activation galactosylated glycans from plasma and IgG glycoproteins (FDR<0.05). Conclusion: Our data provide multiple layers of evidence that a previously unappreciated factor with significant clinical implications, disruption in gut barrier integrity, is a potential force that contributes to COVID-19 severity.

14.
Vaccines (Basel) ; 9(4):16, 2021.
Article in English | MEDLINE | ID: covidwho-1208905

ABSTRACT

The ongoing coronavirus disease (COVID-19) pandemic is caused by a new coronavirus (severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2)) first reported in Wuhan City, China. From there, it has been rapidly spreading to many cities inside and outside China. Nowadays, more than 110 million cases with deaths surpassing 2 million have been recorded worldwide, thus representing a major health and economic issues. Rapid development of a protective vaccine against COVID-19 is therefore of paramount importance. Here, we demonstrated that the recombinantly expressed receptor-binding domain (RBD) of the spike protein can be coupled to immunologically optimized virus-like particles derived from cucumber mosaic virus (CuMV<sub>TT</sub>). The RBD displayed CuMV<sub>TT</sub> bound to ACE2, the viral receptor, demonstrating proper folding of RBD. Furthermore, a highly repetitive display of the RBD on CuMV<sub>TT</sub> resulted in a vaccine candidate that induced high levels of specific antibodies in mice, which were able to block binding of the spike protein to ACE2 and potently neutralize SARS-CoV-2 virus in vitro.

15.
Vaccines (Basel) ; 9(4):19, 2021.
Article in English | MEDLINE | ID: covidwho-1208455

ABSTRACT

COVID-19 is a novel disease caused by SARS-CoV-2 which has conquered the world rapidly resulting in a pandemic that massively impacts our health, social activities, and economy. It is likely that vaccination is the only way to form "herd immunity" and restore the world to normal. Here we developed a vaccine candidate for COVID-19 based on the virus-like particle AP205 displaying the spike receptor binding motif (RBM), which is the major target of neutralizing antibodies in convalescent patients. To this end, we genetically fused the RBM domain of SARS-CoV-2 to the C terminus of AP205 of dimerized capsid proteins. The fused VLPs were expressed in E. coli, which resulted in insoluble aggregates. These aggregates were denatured in 8 M urea followed by refolding, which reconstituted VLP formation as confirmed by electron microscopy analysis. Importantly, immunized mice were able to generate high levels of IgG antibodies recognizing eukaryotically expressed receptor binding domain (RBD) as well as spike protein of SARS-CoV-2. Furthermore, induced antibodies were able to neutralize SARS-CoV-2/ABS/NL20. Additionally, this vaccine candidate has the potential to be produced at large scale for immunization programs.

16.
Eur J Cardiothorac Surg ; 60(1): 203, 2021 07 14.
Article in English | MEDLINE | ID: covidwho-1040620
19.
J Am Coll Surg ; 231(6): 613-626, 2020 12.
Article in English | MEDLINE | ID: covidwho-753355

ABSTRACT

BACKGROUND: The COVID-19 pandemic disrupted the delivery of surgical services. The purpose of this communication was to report the impact of the pandemic on surgical training and learner well-being and to document adaptations made by surgery departments. STUDY DESIGN: A 37-item survey was distributed to educational leaders in general surgery and other surgical specialty training programs. It included both closed- and open-ended questions and the self-reported stages of GME during the COVID-19 pandemic, as defined by the ACGME. Statistical associations for items with stage were assessed using categorical analysis. RESULTS: The response rate was 21% (472 of 2,196). US stage distribution (n = 447) was as follows: stage 1, 22%; stage 2, 48%; and stage 3, 30%. Impact on clinical education significantly increased by stage, with severe reductions in nonemergency operations (73% and 86% vs 98%) and emergency operations (8% and 16% vs 34%). Variable effects were reported on minimal expected case numbers across all stages. Reductions were reported in outpatient experience (83%), in-hospital experience (70%), and outside rotations (57%). Increases in ICU rotations were reported with advancing stage (7% and 13% vs 37%). Severity of impact on didactic education increased with stage (14% and 30% vs 46%). Virtual conferences were adopted by 97% across all stages. Severity of impact on learner well-being increased by stage-physical safety (6% and 9% vs 31%), physical health (0% and 7% vs 17%), and emotional health (11% and 24% vs 42%). Regardless of stage, most but not all made adaptations to support trainees' well-being. CONCLUSIONS: The pandemic adversely impacted surgical training and the well-being of learners across all surgical specialties proportional to increasing ACGME stage. There is a need to develop education disaster plans to support technical competency and learner well-being. Careful assessment for program advancement will also be necessary. The experience during this pandemic shows that virtual learning and telemedicine will have a considerable impact on the future of surgical education.


Subject(s)
COVID-19 , Education, Medical, Graduate/trends , Health Status , Specialties, Surgical/education , Students , COVID-19/epidemiology , COVID-19/prevention & control , Cross-Sectional Studies , Education, Medical, Graduate/methods , Education, Medical, Graduate/organization & administration , General Surgery/education , General Surgery/trends , Humans , Learning , Pandemics , Specialties, Surgical/trends , Students/psychology , Surveys and Questionnaires , United States/epidemiology
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