SARS-CoV-2 infection (COVID-19) in children.

Since the outbreak in December 2019, the SARS-CoV-2 pandemic virus has been a major public health problem in all countries of the world. The virus is transmitted by inhalation of respiratory droplets from the patient or asymptomatic carrier and is highly contagious. The clinical disease in children is similar to any acute respiratory infection with predominant upper respiratory symptoms, but occasionally can progress to pneumonia with acute respiratory distress syndrome and multiorgan failure. The disease is milder in children than in adults, with low mortality, and it appears that infants and young children have a somewhat more severe clinical course. Diagnosis is made by detecting the virus from respiratory samples (mainly nasopharyngeal and oropharyngeal swabs) using polymerase chain reaction. Treatment is usually symptomatic, and in severe and critical forms, the use of one of the antiviral drugs (lopinavir-ritonavir, remdesivir, hydroxychloroquine) may be consideredCopyright © 2020 Croatian Paediatric Society. All rights reserved.

The impact of COVID-19 epidemic on the control of important parasitic diseases.

The spread of COVID-19 has increased the risk of contact transmission between people, and imposes challenges and opportunities for the prevention and control of important parasitic diseases. There may be risks of COVID-19 infection during the implementation of the virus control, including in field investigation and intervention, contacting with fecal samples, or with asymptomatic infected people. Therefore, corresponding prevention and control measures should be taken before and during field investigation, and in sample transportation and detection to prevent the risks effectively. In this paper, the risks and corresponding countermeasures in the above processes are discussed in detail, and the opportunities that COVID-19 brought to the disease control system are also analyzed.Copyright © 2021, National Institute of Parasitic Diseases. All rights reserved.

COVID-19 screening in asymptomatic patients scheduled for surgery. What is the role of rt-PCR in elective procedures during the pandemic?

Background: COVID-19 has changed medical practice nowadays. One of the biggest concerns has been establishing when invasive procedures such as surgery, GI endoscopy or bone marrow transplant are safe;and if it is necessary to consider screening for asymptomatic patients. Method(s): We identified asymptomatic patients that were scheduled for invasive procedures from May 2020 to April 2021 at Clinica de Marly. Patients were asked to fill a questionnaire about GI and upper respiratory symptoms and contact with possible/confirmed cases of COVID- 19 in the last 15 days. Patients taken to emergency procedures, who had symptoms or contact with probable/confirmed cases in the last 15 days were excluded. rt-PCR was performed to screen COVID-19. Result(s): A total of 1837 patients were included. 104 rt-PCRs tested positive for SARS-CoV-2, leading to a 5.66% of identified asymptomatic patients. Patients were followed-up on the 30th day after the procedure. 1733 negative patients responded to our follow-up, in which only 1 death and 2 complications were detected. 102 positive patients were followed-up and no complications or deaths were reported. Conclusion(s): We found the presence of 5.66% of asymptomatic patients with positive rt-PCR for COVID-19. Safe screening will decide if these invasive interventions can be postponed, or, if the benefit outweighs the risks.Copyright © 2022 Asociacion Colombiana de Infectologia. All rights reserved.

Knowledge, attitude, and practices regarding second waves of COVID-19: A cross-sectional study among rural population in India

Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus. Most people infected with the COVID-19 virus will experience mild to moderate respiratory illness and recover without requiring special treatment. Older people, and those with underlying medical problems like cardiovascular disease, diabetes, chronic respiratory disease, and cancer are more likely to develop serious illness. The best way to prevent and slow down transmission is to be well informed about the COVID-19 virus, the disease it causes and how it spreads. Protect yourself and others from infection by washing your hands or using an alcohol based rub frequently and not touching your face. The aim of the present study was assess the Knowledge, attitude, and practices regarding of COVID-19: among rural population.Cross-sectional questionnaire-based study was conducted on rural people A total of 200 participants hailing from rural areas were enrolled. Result(s): Most common source of information for the participants was through television (54.8%) and radio (49.2%). Only 77% claimed that they were using face mask and 72% claimed to be following social distancing. A large (60%) proportion of the participants did not know that COVID-19 could spread from asymptomatic patients. The mean (percentage) scores of knowledge, attitude, and practice were 21.26 (82%), 9.37 (92%), and 10.32 (86%), respectively. Education of participants was a key determinant for use of social distancing and face mask as a preventive tool. With increasing age, the practice of social distancing and the use of face mask were decreasing in our study. Conclusion(s): Television/Radio channels form an important source of information and need to be used more effectively to educate the people about the disease and create awareness about effective preventive measures. People need to be educated about the role of asymptomatic carriers in spreading the disease.Copyright © 2020 Ubiquity Press. All rights reserved.

Non-Pharmaceutical Interventions are Measures to Control Coronavirus Disease-2019 (COVID-19) Transmission in India

The coronavirus disease 19 (COVID-19) is a pathogenic and transmittable viral disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and this disease emerged in December 2019 in Wuhan, China. It was later spread across the world, including the United States, Great Britain, Brazil, Russia, Germany, Spain, Italy, Iran, Pakistan, India and other countries. The whole genome of SARS-CoV-2 shared some similarity with the SARS virus, hence bat was a suspected source of the spread of this virus in China. However, human to human transfer was reported. In India, more than 300 COVID-19 cases were reported on March 21, 2020, and these numbers were increased as 892551 on July 13, 2020. These numbers of COVID-19 cases were detected from a total of 11806256 samples according to the report given by the Government of India. On July 13, Maharashtra state of India recorded a total of 254427 cases and 10289 deaths were registered. Tamilnadu was another state that screened more number of COVID-19 cases, followed by Maharashtra. On July 6, 114978 COVID-19 cases were reported in Tamilnadu and 1571 deaths were recorded. In Tamilnadu alone, over 3000 COVID-19 cases were reported daily from July first week to the second week and total cases were 142798 on July 13, 2020. Among these cases, 78573 COVID-19 cases were detected in Chennai city alone accounted for about 62% of total COVID-19 cases. It was earlier believed that patients over aged 60 and less than 10 were highly vulnerable to this disease. However, this disease affected all age groups. To prevent COVID-19, no approved antiviral vaccine or drug has yet been discovered. COVID-19 is transmitted through droplets during coughing and sneezing by symptomatic and asymptomatic carriers. Non-pharmaceutical interventions such as washing hands and social distancing are effective measures to control COVID-19 transmission in India. The present study was designed to analyze the control measures of COVID-19 infection and ground reality to control the COVID-19 outbreak.Copyright © 2021 Bentham Science Publishers.

How big of an impact do asymptomatic people have on the dynamics of an epidemic?

Asymptomatic carriers serve as a potential source of transmission of epidemic diseases. Exposed people who develop symptoms only get tested and remain isolated in their homes or sometimes in hospitals when needed. In contrast, the asymptomatic individuals go untested and spread the disease silently as they roam freely throughout their entire infectious lifetime. The work intends to explore the role of asymptomatic carriers in the transmission of epidemic diseases and investigate suitable optimal control strategies. We propose a SEIAQR compartmental model subdividing the total population into six different compartments. To illustrate the model's implication, we estimate the number of asymptomatic individuals using COVID-19 data during June 9–July 18, 2021 from Bangladesh. We then analyze the model to explore whether the epidemic subsides if the asymptomatic individuals are tested randomly and isolated. Finally, to gain a better understanding of the potential of this unidentified transmission route, we propose an optimal control model considering two different control strategies: personal protective measures and isolation of asymptomatic carriers through random testing. Our results show that simultaneous implementation of both control strategies can reduce the epidemic early. Most importantly, sustained effort in identifying and isolation of asymptotic individuals allows relaxation in personal protective measures. © 2023

A Study of Prevalence of Igg Antibodies against Covid 19 in Maternal and Cord Blood

Introduction: The pandemic of COVID-19 has spread a wave of insecurity, fear and anxiety because of unknown facts about the pathogen. To have a better understanding about this infection, a systematic study is required by the principles of epidemiology with detailed investigations and researches from different angles. Hence, we are undertaking the study of seroprevalence of IgG antibody to get the idea about herd immunity in pregnant patients coming for delivery and their newborns. Objective(s): To find out the correlation between subclinical attack / mild attack of COVID 19 in the antenatal period. Method(s): This Cross-sectional study was conducted after getting cleared from Board of Studies and Ethical committee. The study population was calculated to be of 500 serum samples of both mother and newborns each. Result(s): The maternal age was 20-25 years among 230 (36.0%), 26-30 years among 164 (32.8%), 31-35 years among 88 (17.6%) and > 35 years among 18 (3.6%) patients. The maternal gestational age was <37 weeks 0 days at the time of delivery in 82 (16.4%) and that of >= 37 weeks was 418 (83.6%) patients. The exposure of COVID 19 virus and/or even the asymptomatic carriers, led to a data showing 18% (90 patients) of the study population being affected in 2nd trimester, 48.6% (243 patients) in 3rd trimester and 33.4% (167 patients) not affected at all in the pregnancy. IgG in mother at delivery was present among 21.4 % mothers. IgG in cord blood was present among 12.0% newborns. Conclusion(s): Although even at the time of diagnosis, asymptomatic pregnant women are able to reliably build a powerful IgG for receptor binding domain with neutralising response to COVID 19, as our results reveal. In addition, our findings indicate that this reaction was long-lasting, which lends credence to the notion that immunisation in this population will be successful. And after extensive research studies, pregnant females were allowed to be vaccinated against COVID 19. Copyright © 2022 Authors. All rights reserved.

THAT BLOODY CLOT DOES NOT ALWAYS NEED A TUNNEL TO MIGRATE: A CASE OF MULTIPLE ARTERIAL AND VENOUS THROMBOSIS IN A COVID-19 PATIENT

SESSION TITLE: Rare Cases of Nervous System and Thrombotic Complication Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Covid 19 virus has impacted nearly 450 million people across the globe;ranging from an asymptomatic carrier state to respiratory symptoms, cardiovascular symptoms, hematologic manifestations and multiorgan failure to death. Thrombotic events are one of its devastating complications. CASE PRESENTATION: A 66 year old man with a history of diabetes mellitus, hypertension and 30 pack years smoking history presented to the emergency room with hypoxia and altered mental status. On exam, his GCS was 8/15 and oxygen saturation was 85% on room air. He was subsequently intubated. CTA chest demonstrated bilateral diffuse ground glass opacities and left pulmonary embolism (PE). CT abdomen and pelvis showed multifocal infarcts in the right kidney with findings suggestive of renal artery thrombosis. Initial platelet count was 80,000/ul with creatinine of 3.9 mg/dl and creatine kinase (CK) of 3977 u/l. His INR was 1.4. Patient was not a candidate for thrombolysis given his thrombocytopenia. He was started on intravenous (IV) heparin and given IV hydration. On day 3 of his admission, he developed dry gangrene of the toes. Ankle brachial index of the right lower extremity (LE) was 1.16 and left LE was 0. Duplex ultrasonography of left LE showed mid to distal popliteal artery thrombus occluding below knee popliteal and tibial arteries. Echocardiogram showed ejection fraction of 55% and bubble study was negative for any intra atrial or pulmonary shunting. On day 4 of his admission, he developed oliguria and his gangrene got worse. His platelet counts decreased to 36,000/ul. Other pertinent labs showed INR 1.2, PT 15.3, PTT 34, D dimer 14.82, fibrinogen 498, CK 6434 mg/dl, hemoglobin 13.2 g/dl, haptoglobin 243 mg/dl and LDH 1041 U/l. Given his poor prognosis in the setting of ventilator dependent respiratory failure, multiple thrombosis and kidney failure requiring hemodialysis, the family decided to withdraw care. DISCUSSION: There are multiple hypotheses of thrombus formation in Covid 19 infection such as interleukin 6 and other cytokines induced endothelial injury, angiogenesis and elevated prothrombotic factors such as factor VIII and fibrinogen. Our patient had PE, renal artery thrombosis and popliteal artery thrombosis. Despite being on full dose anticoagulation, he developed gangrene of the toes. His lab results were not consistent with disseminated intravascular coagulation, thrombotic thrombocytopenic purpura and he was not known to have any baseline hypercoagulable disorder. He did not have any intra cardiac shunts. Hence, it is most likely Covid 19 induced multiple arterial and venous thrombosis. CONCLUSIONS: The treatment of Covid 19 related thrombosis has become very challenging especially in the setting of multiple clots. It is crucial to have large multicenter studies to investigate vascular complications of Covid-19 and to formulate management strategies to ensure good patient outcomes. Reference #1: https://www.nejm.org/doi/full/10.1056/nejmoa2015432 Reference #2: https://journal.chestnet.org/article/S0012-3692(21)01126-0/fulltext DISCLOSURES: No relevant relationships by Devashish Desai No relevant relationships by Swe Swe Hlaing no disclosure on file for Jean Marie Koka;No relevant relationships by Hui Chong Lau No relevant relationships by Subha Saeed No relevant relationships by Anupam Sharma No relevant relationships by Muhammad Moiz Tahir

What about infection in travellers, migrants and refugees

Several factors have been linked to emerging infectious diseases including new agents (coronaviruses, zika virus), extension of geographical areas (schistosomiasis, dengue, West Nile, zika virus), increase in incidence (HIV, tuberculosis) and travel/migration (Chagas disease, cysticercosis). According to the World Migration Report 2020, the number of international migrants reached 272 million globally in 2019, and nearly two-thirds were labour migrants. Epidemiological evidence about infectious diseases and neuroinfection among travellers, migrants and refugees will be reviewed. Traveller's diarrhoea, dengue fever and other tropical diseases are reported in travellers. Re-emergence of infections in Europe includes chikungunya, dengue and malaria. Migration of asymptomatic people spread American trypanosomiasis in non-endemic areas and cases have been reported in Europe, Japan, and North-America. Neurocysticercosis is a common cause of seizures among South American migrants in USA. Migrants may be asymptomatic carriers (Chagas, HTLV-1). The involvement of CNS may occur in viral infections (HIV, HTLV-1, dengue, zika), malaria, schistosomiasis (myeloradiculopathy), Chagas disease (encephalitis, stroke), etc. Refugees may be at slightly higher risk of infectious diseases including tuberculosis, HIV, hepatitis and schistosomiasis. Systematic reviews have found that tuberculosis and hepatitis B and C prevalence is higher among migrants arriving in Europe, and the prevalence of antimicrobial resistance and infections was higher in refugees and asylum seekers than in other migrant groups. Infectious diseases in migrants may be explained by a higher prevalence in migrants' countries of origin, barriers to health care in host/transit countries, and poor living conditions. These factors are especially relevant in vulnerable populations (refugees, documented migrants).

Modes of Transmission of Novel Corona Virus (NCov)

BACKGROUND:- The global breakout in the new SARS-Coronavirus 2 have prompted many interrogations concerning this virus's origins & spread. The already stated information of the modes based on transferal also measuring the efficacy in regards to prophylactic estimates will support within limiting this COVID-19 upsurge. SARS-Coronavirus-2 transmission mechanisms have now been identified as respiratory droplets, physical contact and airborne. On the other hand researchers are looking into some of the other possible modes of transmission with some studies showing that the virus spreads through feces-oral, conjunctival secretion(eyes), sexual transmission, mother-to-fetal transmission, surface contact, saliva and asymptomatic carriers. The major goal of this review is to gain a better understanding of SARS-Coronavirus-2 transmission in addition to make exhortation for consist of along with avoiding the novel coronavirus. From its very beginning in Wuhan, China in December 2019, SARS CoV-2 has afflicted more than 31 million people worldwide, resulting in even more than 2 million fatalities. The world continues to be in the dark about a definite therapy for this extremely communicable diseases. Until then, we must depend on tried-and-true techniques to slow or prevent the spread of this viral disease, such as social withdrawal, hand cleanliness, and using a facial mask. OBJECTIVE:- The main goal of that kind of review article would be to focus on various methods of virus infection, comparisons of that kind of virus to similar past equivalency viral diseases including SARS and MERS, & multiple approaches which can be scheduled but are currently being implemented to minimize spread of contagious diseases in organizational citizenship, particularly in India. RESULTS:- According to an examination of many publications on route of transmission, the virus is very infectious and transmits by air droplets, frequent connection, and several conductive materials, and aerosol in the environment with high aerosol producing processes. It could also expand from both the uncomplicated and complicated phases, thus earlier detection is critical. This also mutates in diverse host conditions, thus various strains must be used in vaccine manufacturing. CONCLUSIONS:- Advance identification, social distance, quarantine or positive patients, and pulmonary hygiene are the major weaponry now known to cope with this virus until a suitable therapy or vaccination becomes available very soon, according to the findings. © The Electrochemical Society

Epidemiologic characteristics and differential management strategies of seven case series with COVID-19 outbreaks caused by asymptomatic carriers from June 2020 to May 2021 in China

With the COVID-19 epidemic quickly under control in China in the early stage of 2020, global cooperation/ communications may pose great challenges to epidemic control and prevention in the country. Large-scale spread by asymptomatic carriers was a concern. We obtained data on new cluster outbreak regions with COVID-19 caused by asymptomatic carriers from June 2020 to May 2021 in China, and reported the epidemiological characteristics, the possible routes of viral transmission and infection, and different control strategies. These results show the importance of regular screening for high-risk populations and differential management strategies for epidemic control, which provide an objective basis for suppressing the spread of the SARS-CoV-2 virus. These experiences can be used as a reference to minimize the subsequent spread of virus mutants in various places.

British Cardiovascular Society Annual Conference, '100 years of Cardiology'

The proceedings contain 226 papers. The topics discussed include: mitral valve abnormalities in decedents of sudden cardiac death due to hypertrophic cardiomyopathy and idiopathic left ventricular hypertrophy;prevalence and diagnostic significance of novel 12-lead ECG patterns following COVID-19 infection in elite soccer players;clinical outcomes and myocardial recovery in energetics, perfusion and contractile function after valve replacement surgery in severe aortic stenosis patients with diabetes comorbidity;brain phenotype of takotsubo syndrome;improving the diagnostic accuracy of apical hypertrophic cardiomyopathy;investigating a novel role for nesprin-1 and the linc complex in cardiomyocyte mechanotransduction;transcatheter aortic valve implantation in patients with right bundle branch block: should prophylactic pacing be undertaken?;and disease penetrance in asymptomatic carriers of familial cardiomyopathy variants.

SARS-CoV-2 infection (COVID-19) in children

Since the outbreak in December 2019, the SARS-CoV-2 pandemic virus has been a major public health problem in all countries of the world. The virus is transmitted by inhalation of respiratory droplets from the patient or asymptomatic carrier and is highly contagious. The clinical disease in children is similar to any acute respiratory infection with predominant upper respiratory symptoms, but occasionally can progress to pneumonia with acute respiratory distress syndrome and multiorgan failure. The disease is milder in children than in adults, with low mortality, and it appears that infants and young children have a somewhat more severe clinical course. Diagnosis is made by detecting the virus from respiratory samples (mainly nasopharyngeal and oropharyngeal swabs) using polymerase chain reaction. Treatment is usually symptomatic, and in severe and critical forms, the use of one of the antiviral drugs (lopinavir-ritonavir, remdesivir, hydroxychloroquine) may be considered

Asymptomatic detection of COVID-19 among cancer patients receiving infusional anti-cancer therapy

Introduction Little is known about the rates of asymptomatic COVID-19 carriers among cancer patients. The rate of asymptomatic carriers is important to understand in this population given the use of myelosuppressive and immunomodulating therapies and the risk of transmission to other patients in shared infusion centers. At UC San Diego, in June 2020, we implemented a COVID-19 asymptomatic screening protocol in which cancer patients receiving anti-cancer therapy in an infusion center must undergo symptom-based screening and then SARS-CoV-2 PCR testing prior to their infusion. Here, we describe the results of this asymptomatic screening protocol. Methods This was a single-center retrospective analysis of patients with active cancer receiving infusional anti-cancer therapy in 5 infusion centers who underwent at least 1 asymptomatic SARS-CoV-2 PCR test between 6/1- 12/1/2020. The primary endpoint was the rate of COVID-19 positivity among asymptomatic patients. Symptomatic patients were excluded. Secondary endpoints included COVID-19-related outcomes and patterns of oncologic management for asymptomatic COVID-19 positive patients. Results A cohort of 2,202 cancer patients received at least 1 asymptomatic SARS-CoV-2 PCR test prior to receipt of infusional anti-cancer therapy. 0.95% (N=21/2202) of patients were found to be PCR-positive on asymptomatic screening. Among positive patients, 9.5% (N=2/21) had hematologic malignancies and 90.5% (N=19/21) had solid tumors. In terms of therapy, 76.2% (N=16) were treated with cytotoxic chemotherapy, 9.5% (N=2) with targeted therapy, 4.7% (N=1) with immunotherapy, and 9.5% (N=2) were on a clinical trial. With a median follow-up of 122 days from positive PCR test (range: 8-186), only 2 of 21 (9.5%) of the cohort ultimately developed COVID-related symptoms. Both patients had a diagnosis of acute leukemia and 1 patient required hospitalization for COVID-related complications. No patients died from COVID-related complications. With regards to oncologic management, 95.2% (N=20/21) of patients had their therapy delayed or deferred with a median delay of 21 days (range: 7- 77 days). Only 1 patient proceeded with cytotoxic chemotherapy on schedule in the setting of adjuvant chemoradiation for oropharyngeal squamous cell carcinoma. Among the overall cohort, an additional 26 patients (1.2%) developed cases of symptomatic COVID-19 infection during the study period. Conclusions A strategy of asymptomatic screening of cancer patients receiving anti-cancer therapy in an infusion center detected an extremely low rate of asymptomatic carriers of COVID-19. This low rate of asymptomatic carriers may be due to a number of factors including multiple symptom-based screenings prior to infusion, behavior modification among patients, and/or differential immune responses to COVID-19 infection. Asymptomatic carriers in this cohort appeared to have favorable outcomes with few developing symptoms or requiring hospitalization, though the number of positive patients in our cohort is low, precluding definitive conclusions in this population.

Prospective voluntary SARS-CoV-2 virus and anti-COVID-19 antibody tests in asymptomatic medical and research staff who work in direct contact with cancer patients: A single center study

Background The SARS-CoV-2 pandemic has assaulted all aspects of daily life. Medical professionals in oncology face additional challenges with balancing prompt cancer diagnosis and urgent treatment against potential COVID-19 exposure risk in these high-risk patients. We designed this prospective freewill study to offer testing for SAR2-CoV-2 viral RNA and/or anti-COVID-19, respectively in asymptomatic medical and research staff who work in direct contact with cancer patients. The overall goal was to evaluate the prevalence of infection in this group of asymptomatic healthcare providers to reduce exposure of cancer patients to asymptomatic staff. Methods Asymptomatic medical and research staff who work in direct contact with cancer patients were asked to voluntarily be tested for either SARS-CoV-2 viral RNA or antibodies or both. Either NP swabs and/or blood samples (EDTA tube) were collected. Tests are performed at Sinochips Kansas LLC, Sinochips Diagnostics (CLIA number:17D2176068, CAP number: 8709463). The PCR test is performed with FDA authorized 2019-Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel EUA. The Elecsys® Anti-SARS-CoV-2 (Roche Diagnostics) immunoassay was used to qualitative detection of antibodies to SARS-CoV-2 in human plasma. Results From 06/18/2020 to 12/18/2020, 861 participated in the study. 1095 tests were completed for SAR2-CoV-2 virus infection, and 918 were completed for antibody. Amount participants, 530 had both virus and antibody tested. 235 were tested more than once for viral infection and 166 were tested more than once for the antibody. Median age of participants was 39 years (IQR 32-51 years). Among these 84.7% were females, 84.4% white, 6.7% African American, 4.8% Asian and 84.7% non-Hispanic. The cumulative incidence of a positive test for the virus was 2.2% (16/712), and for the antibody test was 3.8% (26/679). 5 had both viral and antibody tests positive, with an average time of 4.1 weeks from viral testing positivity to detectable antibody among 3 cases and 2 cases with both viral infection and antibody detected at same time. There were 3 cases virus was detected more than once after turning positive. 2 remained positive at 16 and 22 days after initial test and one turned negative at 36 days as of last follow up. There were 7 cases where the antibody was tested more than once after turning positive and all 7 remained positive as of last follow up (range 7-103 days). Conclusion Prospective voluntary testing in asymptomatic medical and research staff who work in direct contact with cancer patients was feasible and resulted in identification of asymptomatic carriers who then placed in quarantine, thereby limiting exposure to cancer patients. Medical and research staff who work with cancer patients are general very cautious and the frequency of infections were significantly lower than general society. In addition, it seems that 1) virus and antibody may co-exist in the same person after exposure, and 2) the antibody may last for a relatively long time.

Buccal swab testing with the AmplideX PCR/CE SMN1/2 Plus Kit that assesses copy number and critical mutations for SMA

Introduction: Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disease that results from mutation of the survival motor neuron 1 gene (SMN1) and the most common genetic cause of infant death. Approximately 95% of SMA cases are caused by a deletion in both alleles of exon 7 in the SMN1 gene. The copy number of the highly homologous SMN2 gene is an important predictor of the severity of SMA as it has been shown to decrease disease severity in a dose-dependent manner. SMN1 and SMN2 only differ by a few nucleotides, presenting a challenge in determining copy numbers. While carriers typically have one copy of SMN1, cis duplication of SMN1 can produce “silent carrier” (2 + 0) genotypes, which are often associated with two SMN1 variants, c.*3 + 80T>G and c.*211_*212del, that can improve the overall carrier detection rate. SMA treatments SPINRAZA®,, Evrysdi™, and ZOLGENSMA® achieve profound benefits on survival and motor milestones by modifying SMN2 splicing or using gene replacement with functional SMN genes. Early detection of SMA (including SMN2 copy number status) and identification of at-risk couples through carrier screening is critical to aid in early intervention and family planning decisions. We developed an accurate and robust single-tube PCR assay and companion software (AmplideX® PCR/CE SMN1/2 Plus Kit*) that uses capillary electrophoresis (CE) to quantify SMN1 and SMN2 copy numbers (0 to ≥4) and determines the presence/absence of the two SMN1 gene duplication “silent carrier” variants, c.*3 + 80T>G and c. *211_*212del, and the SMN2 disease modifier variant c.859G>C. The SMN1/2 Plus Kit has been previously validated for use with DNA isolated from blood. Here, we verify that DNA isolated from buccal swabs can also be used to determine SMN1 and SMN2 copy number and expanded content using this kit. Materials and Methods: A total of 60 DNA samples isolated from buccal swabs, with varying SMN1/2 copies and other positive and negative variants,were tested using the SMN1/2 Plus kit at a single site (Asuragen). Samples were tested in two cohorts: an initial cohort containing 17 samples isolated from buccal swabs with column or magnetic bead-based methods, and a second cohort of 43 samples isolated from matched blood and buccal samples using column-based methods. PCR products were generated using a Veriti thermal cycler and resolved on Applied Biosystems™ 3500xL, 3130xl, 3730xl, and SeqStudio™ Genetic Analyzers. Raw electrophoresis data (.fsa) files were directly imported into an assay-specific analysis module of the AmplideX® Reporter software that automates peak detection and sizebased classification, SMN1 and SMN2 exon 7 copy number quantification, detection of gene duplication and disease modifier variants, and sample- and batch-level quality control checks. Samples were analyzed using the default (kit calibrator) and user-defined calibration (UDC) (buccal DNA) workflows as described in the protocol. Results: For the initial cohort of 17 Buccal swab samples, SMN1 copy number calls were concordant with MLPA reference results (reported as 0, 1, 2, or ≥3) for 16/17 (94.1%) of samples with default calibration and 17/17 (100%) of samples with UDC. Further, concordance for carrier samples (1 SMN1 copy) were 7/7 (100%) using both methods. SMN2 copy numbercallswere concordant with MLPA reference results for 17/17 (100%) of samples with either default calibration or UDC. For the second cohort of 43 buccal swab samples with matched blood samples, SMN1 and SMN2 copy number calls were concordant with the results from the paired whole blood for at least 95% of samples assessed across the four different CE platforms. All variant status calls were concordant between the buccal swab and whole blood results. Conclusions: Here, we demonstrate that buccal swabs are a compatible DNA source for the quantification of 0, 1, 2, 3, and ≥4 gene copies of both SMN1 and SMN2 and the status determination of three clinically significant variants using the single-tube PCR/CE SMN1/2 Plus kit. Although d fault calibration yielded high rates of agreement between copy number results from buccal swabs and reference results, analyzing samples with user-defined calibration (i.e. calibrating to a buccal swab sample) modestly improved concordance. These results suggest that DNA samples isolated from buccal swabs are compatible with this assay and has implications for more facile sample collection and handling, particularly given the strain of COVID-19 on healthcare infrastructure.

Case SEries: Nasal Antimicrobial Photodisinfection (APDT) as Treatment Protocol for Asymptomatic and Early Stage COVID-19 Patients

Background. Targeted reduction of SARS-CoV-2 viral load in the nose may mitigate the severity of lower tract respiratory disease as well as reduce hospitalization and mortality rates. Nasal Photodisinfection has been deployed for 10 years in Canadian hospitals reducing post-surgical infections. The objective of thiswork was to demonstrate effectiveness of APDT in early stage COVID-19 and asymptomatic carriers. Methods. A cohort of 40 COVID-19 positive patients were treated with nasal photodisinfection (Steriwave) at a private clinic. All patients were previously identified by PCR as SARS-CoV-2 positive and admitted into the treatment cohort. BD rapid antigen nares testing was used before and after Photodisinfection treatment. Of the 40 patients, 13 were female and 27 were male. Age range was 9- 56 years of age. Treatment involved 3-4 applications of photosensitizer and 16-24 minutes per patient of treatment time. Patients were followed up within 24 hours, 48 hours as well as day 5 and 6 and day 10/11. Patients filled out a COVID-19 score card. Results. Results demonstrated APDT was capable of significant and rapid viral load reduction in COVID-19 carriers. 100% of patients were converted from positive rapid antigen test to negative. 60% of patients reported fever resolution within 24 hours. Fever resolution occurred in 100% of patients within 48hours. Moreover, results demonstrated accelerated resolution of COVID-19 symptoms and significantly improved mental health benefits from reduction of COVID-19 related stress and anxiety. None of the patients experienced severe symptoms and no patients were hospitalized. Safety outcomes demonstrated no patient safety issues with only minor transient side effects (rhinorrhea, sneezing) observed. Moreover, the treatment procedure was pain-free and well tolerated by all patients. Conclusion. Photodisinfection-based nasal decolonization anti-viral efficacy was demonstrated with improved outcomes for all patients treated in this case series. Significant rapid viral load reduction was confirmed by rapid antigen tests in all patients. More clinical studies are warranted in support of Photodisinfection based therapy for upper respiratory infections such as COVID-19.

The Positive Rate of Nucleic Acid Testing and the Epidemiological Characteristics of COVID-19 in Chongqing.

OBJECTIVE: The purpose of this study is to analyze the positive rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid testing (NAT), cases of and deaths due to SARS-CoV-2, and the epidemiological characteristics of SARS-CoV-2 to identify high-risk populations. METHODS: A retrospective study in Jiulongpo district of Chongqing was conducted by performing continuous observations of the frequency of SARS-CoV-2 NAT, analyzing the data of close contacts of patients and asymptomatic carriers, and collecting epidemiological data. Data were collected from January 20, 2020, when the first case of SARS-CoV-2 infection was reported, to March 26, 2020. Descriptive statistical analysis and Cochrane-Mantel-Haenszel analysis were used to compare the positive detection rates and positive diagnostic rates of different exposure groups. RESULTS: A total of 7,118 people received 10,377 SARS-CoV-2 nucleic acid tests in one district, and the SARS-CoV-2 positive rates were 0.40% (18/4446) and 0.15% (4/2672) in people receiving one and ≥ two nucleic acid tests (p = 0.06), respectively. Those with suspected cases (12.35%) and close contacts (8%) had higher positive rates than people tested at fever clinics (0.39%) (p < 0.001). The median latency (range) of cases was 5 (2, 9) days, and the median time from diagnosis to recovery was 22 (14, 25) days. One recovered patient received a positive test result at 28 days after recovery when she attempted to donate blood. Six clustered cases, including one patient who died, indicated persistent human-to-human transmission. One patient who was diagnosed after death was found to have infected 13 close contacts. People working in catering and other public service departments (36.36%) and people who are unemployed and retirees (45.45%) have an increased risk of infection compared with technical staff (9.09%) and farmers (9.09%). CONCLUSION: The total positive rate was low in the tested population, and more effective detection ranges should be defined to improve precise and differentiated epidemic control strategies. Moreover, in asymptomatic carriers, SARS-CoV-2 tests were positive after recovery, and patients with suspected SARS-CoV-2 infection who die may pose serious potential transmission threats.

Clinical and echocardiographic risk score predicts need for hospitalization among patients with COVID-19

Background: Age and medical co-morbidities are known predictors of disease severity in coronavirus disease-2019 (COVID-19). Whether baseline transthoracic echocardiographic (TTE) abnormalities could refine riskstratification in this context remains unknown. Purpose: To analyze performance of a risk score combining clinical and pre-morbid TTE features in predicting risk of hospitalization among patients with COVID-19. Methods: Adult patients testing positive for COVID-19 between March 1st and October 31st, 2020 with pre-infection TTE (within 15-180 days) were selected. Those with severe valvular disease, acute cardiac events between TTE and COVID-19, or asymptomatic carriers of virus (on employment screening/nursing home placement) were excluded. Baseline demographic, clinical co-morbidities, and TTE findings were extracted from electronic health records and compared between groups stratified by hospital admission. Total sample was randomly split into training (≈70%) and validation (≈30%) sets. Age was transformed into ordered categories based on cubic spline regression. Regression model was developed on the training set. Variables found significant (at p<0.10) on univariate analysis were selected for multivariate analysis with hospital admission as outcome. β-coefficients were obtained from 5000 bootstrapped samples after forced entry of significant variables, and scores assigned using Schneeweiss's scoring system. Final risk score performance was compared between training/ validation cohorts using receiver-operating curve (ROC) and calibration curve analyses. Results: 192 patients were included, 83 (43.2%) were admitted. Clinical/ TTE characteristics stratified by hospitalization are in Table 1. Moderate or worse pulmonary hypertension and left atrial enlargement were only TTE parameters with coefficients deserving a score (Table 1). The risk score had excellent discrimination in training and validation sets (figure 1 left panel;AUC 0.785 versus 0.836, p=0.452). Calibration curves showed strong linear correlation between predicted and observed probabilities of hospitalization in both training and validation sets (Figure 1, middle and right panels, respectively). ROC analysis revealed a score ≥7 as having best overall quality with sensitivity and specificity of 70-75% in both training and validation sets. A score ≥12 had 98% and 97% specificity and ≥14 had 100% specificity. Conclusion: A combined clinical and echocardiographic risk score shows promise in predicting risk of hospitalization among patients with COVID- 19, and hence help anticipate resource utilization. External validation and comparison against clinical risk score alone is worth further investigation. (Figure Presented).

Epidemiological Characteristics of Sporadic Nosocomial COVID-19 Infections From June 2020 to June 2021 in China: An Overview of Vaccine Breakthrough Infection Events.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has wreaked havoc on millions of people around the world. Although China quickly brought the Coronavirus disease (COVID-19) under control, there have been several sporadic outbreaks in different regions of China since June 2020. This article described the chronological nosocomial COVID-19 infection events related to several sporadic outbreaks of SARS-CoV-2 in different regions of China. We have reported epidemiological characteristics and management measures of sporadic nosocomial COVID-19 infections from June 2020 to June 2021 and specially focused on the domestic COVID-19 breakthrough infection in China, such as domestic COVID-19 breakthrough infection-a vaccinated healthcare professional working in the isolation ward of a designated COVID-19 hospital.