Screening and monitoring patients with COVID-19 pneumonia treated with immunosuppressive agents for hepatitis B reactivation.

Immunosuppressive drugs are used for treating coronavirus disease 2019COVID-19pneumonia. This study examined the current status of screening and monitoring patients with COVID-19 pneumonia treated with immunosuppressive agents for hepatitis B virusHBVreactivation. Of 123 patients whose hepatitis B surface antigen level was measured, 2 were HBsAg-positive. Antihepatitis B core/surface antibodies were measured in all 121 HBsAg-negative patients. HBV DNA was measured in 31 of 32 patients who were positive for either or both antihepatitis B core/surface antibodies. Of 34 patients requiring regular monitoring, only 4 were monitored. The HBV monitoring rate at the initiation of COVID-19 treatment was high. How-ever, HBV monitoring after COVID-19 treatment was difficult because most patients were transferred to other hospitals or had their treatment terminated.Copyright © 2022 Takeshi Matsui et al.

A pre-existing case of HBV infection with elevated HBV DNA after COVID-19 pneumonia treatment.

The patient presented with fever and appetite loss. Computed tomography (CT) revealed a moderate grade 2 pneumonia. Besides, further blood examination showed his HB antigen as negative, anti-HBs/c anti-body as positive, and HBV DNA level as 1.0 LIU/mL. Therefore, he was diagnosed with COVID-19. Administered treatments comprised oxygen inhalation and steroid therapy, including pulses, remdesivir, and baricitinib, which improved pneumonia. Interestingly, one month posttreatment, his HBV DNA level in-creased to 1.4 LIU/mL, followed by a further increase to 1.7 LIU/Ml, showing an improvement. Tenofovir alafenamide fumarate was thus administered. In clinical practice, immunosuppressive therapy is used for patients with moderate-to-severe COVID-19 pneumo-nia. However, close attention should also be paid to the elevation of blood HBV DNA levels during and after treatment.Copyright © 2022 The Japan Society of Hepatology.

A Hepatitis B Virus Reactivation Case Potentially Triggered by the Onset of Diffuse Large B Cell Lymphoma.

An 81-year-old man underwent rituximab-containing chemotherapy for chronic lymphocytic leukemia (CLL). Thirteen years after his last chemotherapy, he was diagnosed with hepatitis B virus (HBV) reactivation. He was then treated with entecavir, and improvement was seen in his liver injury. He developed diffuse large B cell lymphoma (DLBCL) after improvement in his hepatitis. Despite chemotherapy, he contracted the coronavirus disease 2019 (COVID-19) and died of COVID-19. We suspect that HBV reactivation was triggered by DLBCL. When HBV reactivation occurs a long time after chemotherapy has concluded, the onset of DLBCL should be considered.

Biapenem, a Carbapenem Antibiotic, Elicits Mycobacteria Specific Immune Responses and Reduces the Recurrence of Tuberculosis.

Tuberculosis (TB) still tops the list of global health burdens even after COVID-19. However, it will sooner transcend the current pandemic due to the prevailing risk of reactivation of latent TB in immunocompromised individuals. The indiscriminate misuse and overuse of antibiotics have resulted in the emergence of deadly drug-resistant variants of Mycobacterium tuberculosis (M.tb). This study aims to characterize the functionality of the carbapenem antibiotic-Biapenem (BPM) in generating long-lasting immunity against TB. BPM treatment significantly boosted the activation status of the innate immune arm-macrophages by augmenting p38 signaling. Macrophages further primed and activated the adaptive immune cells CD4+ and CD8+ T-cells in the lung and spleen of the infected mice model. Furthermore, BPM treatment significantly amplified the polarization of T lymphocytes toward inflammatory subsets, such as Th1 and Th17. The treatment also helped generate a long-lived central memory T-cell subset. The generation of central memory T lymphocyte subset upon BPM treatment in the murine model led to a significant curtailing in the recurrence of TB due to reactivation and reinfection. These results suggest the potentiality of BPM as a potent adjunct immunomodulator to improve host defense against M.tb by enriching long-term protective memory cells. IMPORTANCE Tuberculosis (TB) caused by Mycobacterium tuberculosis (M.tb) tops the list of infectious killers around the globe. The emergence of drug-resistant variants of M.tb has been a major hindrance toward realizing the "END TB" goal. Drug resistance has amplified the global burden toward the quest for novel drug molecules targeting M.tb. Host-directed therapy (HDT) offers a lucrative alternative to tackle emerging drug resistance and disease relapse by strengthening the host's immunity. Through our present study, we have tried to characterize the functionality of the carbapenem antibiotic-Biapenem (BPM). BPM treatment significantly augmented long-lasting immunity against TB by boosting the innate and adaptive immune arms. The generation of long-lived central memory T lymphocyte subset significantly improved the disease outcome and provided sterilizing immunity in the murine model of TB. The present investigation's encouraging results have helped us depict BPM as a potent adjunct immunomodulator for treating TB.

Can the COVID-19 Vaccine Cause Recrudescence of Herpes Zoster Virus While Taking Antiviral Medication?

Coronavirus disease 2019 (COVID-19) represents a multisystem disease that has caused a devastating global pandemic. The COVID-19 vaccine produced in response to the pandemic has been effective but can have side effects. One well-established condition is the reactivation of herpes zoster (HZ). Various risk factors increase the risk of HZ reactivation such as age, infections, and immunosuppressed states. HZ can have severe complications, including herpes zoster ophthalmicus and postherpetic neuralgia. Here, we present a unique case where a patient experienced HZ reactivation after both primary doses of the COVID-19 vaccine despite receiving early antiviral treatment.

How Reactivation of SARS-CoV-2 in Astronauts with Dysregulated Immune Systems Can Negatively Affect the Odds of Success in Future Space Missions.

We have previously reported that during future space missions the risk of severe COVID-19 infection will be a cardinal issue that needs careful attention. Our studies show that even with the most reliable pre-mission screening and quarantine strategies, astronauts with a latent (hidden, inactive, or dormant) SARS-CoV-2 infection might be sent to space. Given this consideration, an asymptomatic individual with dormant SARS-CoV-2 infection may successfully pass all the pre-launch medical tests. Then during a space mission such as a journey to Mars or beyond, when the immune system of these astronauts starts to weaken, the dormant infection may progress to a severe infection that possibly affects the chance of the mission's success. The effects of microgravity and the elevated space radiation are two key factors that should be evaluated. Furthermore, the limited size of the spacecraft, the proximity of crew members during flight operations, spacecraft atmospheric composition, limited exercise capability, effects of viral response to space radiation, and uncertainty in the likelihood of the virus to mutate and evolve during a space mission merit additional study.

The Proposal of Former President Lenin Moreno Garces for the Granting of General Regulations of the Organic Law of Humanitarian Support, in Ecuador and the Current Ones of President Guillermo Lasso 2020 - 2023

This research analyzes the proposal of former President Lenin Moreno Garces for the granting of the proposal of the General Regulation of the Organic Law of Humanitarian Support to combat the health crisis derived from COVID 19, in Ecuador in 2020. The Humanitarian Support Law includes labor measures such as the option of signing agreements between employers and workers, a new type of fixed-term contract for an emerging special purpose, reduction of working hours, early vacation, and teleworking. In addition, the interpretation of fortuitous event or force majeure as grounds for dismissal is established. Within the solidarity measures for social welfare and productive reactivation, it was provided that the pensiones some alternatives such as the reduction and analysis of educational pensions, in the case of temporary eviction in the matter of tenancy: In order for the lessee of a commercial premises to benefit from the temporary suspension referred to in article 4 of the Law, you must pay your landlord at least twenty percent (20%) of the value of any royalties outstanding or due;and submit to the lessor the VAT returns for both the month of February 2020, the n or increase in costs in basic services was considered, Prohibition of cancellation or suspension of coverage of contracts, Rescheduling of life insurance quotas, Productive credits for economic reactivation and protection of employment in the private sector, Annual motor vehicle tax, Labor stability, Exceptional pre-bankruptcy agreements, Financial institutions: In the case of financial institutions, the debtor will maintain its credit rating for the duration of the mediation process and this will maintain the rating granted the month prior to the entry of its request to initiate the pre-bankruptcy agreement to a Mediation Center. In the case of obligations or debts restructured or novated through pre-bankruptcy agreements with the National Customs Service. Ecuadorian Social Security Institute, public financial institutions, Decentralized Autonomous Governments (GADS), public companies, among others, will become enforceable when the pre-bankruptcy payment agreement has been formalized, forself-financed post-graduate doctors and scholarship holders who are providing their services in the health system in the months since the declaration of the emergency until the issuance of this Regulation, and who are in their training period, sign a contract for occasional services, on the scale of public servant 7 (SP7), With these measures help people who lost their jobs or family members who lost their lives with the pandemic in the health crisis due to COVID 19

Impact of Thymic Response in COVID-19 Pneumonia on Disease Severity and Mortality-As Assessed on CT-Chest

Objective: To determine the effect of thymic response to COVID-19 pneumonia on imaging and its impact on disease severity and outcome. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging (AFIRI), Rawalpindi Pakistan, from Mar to Jul 2020. Methodology: A total of 1620 COVID-19 patients above the age of 18, of either gender, were included in the study. Their findings on High-Resolution CT (HRCT) chest were recorded and graded according to the CT severity score (CTSS) out of a total of 40;less than or equal to 19 was taken as mild while >20 scores were considered as severe disease. The thymic response was assessed by imaging appearance on CT and was graded from 0-3 as follows: fatty, predominantly fatty, mixed density (fat and soft density), and soft density. Fatty replacement implied thymic involution, while soft density depicted a reactivation of thymic tissue after a disease process depictive adequate thymic response. Results: A significant difference in thymic response was observed in patients of different age groups (p<0.001), with the younger age group demonstrating thymic reactivation/ response in the majority (170/244, 69.7%). CT severity score and mortality were significantly higher in older patients demonstrating poor thymic response to COVID pneumonia. Conclusion: Response of the thymus to acute viral infection by Sars COVID-19 is impaired as age progresses;this accounts for greater disease severity, morbidity and mortality in older patients.

Differential Association of Cytomegalovirus with Acute and Post-Acute Covid-19

Background: Asymptomatic Cytomegalovirus (CMV) infection reshapes systemic immune responses and its replication can be both a consequence and cause of inflammation. As CMV resides in the same tissues affected by SARSCoV- 2, we hypothesized that asymptomatic CMV co-infection might modify the pathogenesis of both acute and post-acute COVID-19. Method(s): Participants had current or prior nucleic acid-confirmed SARS-CoV-2 infection in the COVID-19 Multi-Phenotyping for Effective Therapies (COMET, n=219), Immunophenotyping Assessment in a COVID-19 Cohort (IMPACC, n=244) or the Long-term Impact of Infection with Novel Coronavirus (LIINC, n=327) cohorts. We assessed the relationship between CMV serostatus and odds of hospitalization and plasma SARS-CoV-2 N antigen levels during acute COVID-19 as well as post-acute "Long COVID" symptoms, defined as >=1 of 32 COVID-19-attributed symptoms present at least 60 days following initial symptom onset. Result(s): Among 758 participants, 518 were hospitalized for their acute COVID-19 episode. CMV seropositivity was independently associated with a 1.9-fold increased odds of hospitalization for acute COVID-19, after adjustment for age, sex, race, ethnicity, HIV status, prior autoimmune disease, diabetes, and obesity (p=0.01, A). Among those hospitalized, CMV seropositivity was also associated with higher plasma SARS-CoV-2 N antigen levels (median 936 vs. 323 pg/ml, P=0.03, B), which remained significant after adjustment for potential confounders, but not with ICU admission (n=209), death (n=58), or thrombotic events (n=31). In contrast to its relationship to acute COVID-19 disease severity, CMV seropositivity was independently associated with a 48% decreased odds of having neurocognitive Long COVID symptoms such has headache and brain fog 4 months after initial COVID-19 diagnosis (P=0.036). Conversely, serologic evidence of Epstein-Barr Virus (EBV) reactivation and HIV both increased the odds of these symptoms (C). Conclusion(s): CMV seropositivity is associated with a 1.9-fold higher odds of hospitalization in people with acute COVID-19 and a nearly 3-fold higher SARS-CoV-2 antigen burden in hospitalized patients. In contrast, CMV seropositivity is associated with a decreased odds of neurocognitive Long COVID symptoms, while other chronic viral co-infections like EBV reactivation and HIV are associated with an increased odds of this complication. The biologic mechanisms mediating these relationships are unknown, but warrant further investigation. (Figure Presented).

Viral persistence, reactivation, and mechanisms of long COVID.

The COVID-19 global pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has infected hundreds of millions of individuals. Following COVID-19 infection, a subset can develop a wide range of chronic symptoms affecting diverse organ systems referred to as post-acute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID. A National Institutes of Health-sponsored initiative, RECOVER: Researching COVID to Enhance Recovery, has sought to understand the basis of long COVID in a large cohort. Given the range of symptoms that occur in long COVID, the mechanisms that may underlie these diverse symptoms may also be diverse. In this review, we focus on the emerging literature supporting the role(s) that viral persistence or reactivation of viruses may play in PASC. Persistence of SARS-CoV-2 RNA or antigens is reported in some organs, yet the mechanism by which they do so and how they may be associated with pathogenic immune responses is unclear. Understanding the mechanisms of persistence of RNA, antigen or other reactivated viruses and how they may relate to specific inflammatory responses that drive symptoms of PASC may provide a rationale for treatment.

Cytomegalovirus reactivation with high viral load in a patient of coronavirus disease 2019 acute respiratory distress syndrome: a case report.

INTRODUCTION: Cytomegalovirus establishes life-long latency after primary infection in childhood. Cytomegalovirus reactivation has been well reported in immune-compromised patients; however, in the last few years it has been observed that cytomegalovirus reactivation also occurs in critically ill patients without exogenous immunosuppression, which increases length of intensive care unit stay and mortality rate. CASE REPORT: A 63-year-old Indian male, without any known comorbidity, developed severe coronavirus disease 2019 and was admitted to the intensive care unit. He received remdesivir, tocilizumab, steroids, anticoagulants, and empiric antibiotics over the next 3 weeks. However, his clinical condition did not improve much, and during the 9th week of illness his condition started deteriorating and routine bacterial cultures, fungal cultures, and cytomegalovirus real-time polymerase chain reaction on blood were negative. His clinical condition worsened rapidly, which led to the need for invasive mechanical ventilation. Tracheal aspirate bacterial and fungal culture showed no growth, but cytomegalovirus real-time polymerase chain reaction showed 21,86,000 copies/mL in tracheal aspirates. After 4 weeks of ganciclovir treatment, the patient improved clinically and was discharged. Currently he is doing well and able to do his routine activity without the need of oxygen. CONCLUSION: Timely management with ganciclovir is associated with favorable outcome in cytomegalovirus infection. Thus, it can be suggested that treatment should be initiated with ganciclovir if a patient with coronavirus disease 2019 has high cytomegalovirus load in tracheal aspirates, along with unexplained and prolonged clinical and/or radiological features.

When two viruses collide: coronavirus disease after hepatitis B virus reactivation.

The COVID-19 pandemic has exploded since the first cases were reported in Wuhan in December 2019, engulfing the globe. Many infected individuals are asymptomatic or have a mild or moderate disease. A subset of people with advanced age, the immunocompromised and those with chronic diseases, are prone to serious-to-critical illness. We report a fatal case of metastatic colorectal cancer survivor who developed COVID-19 after clinically reactivated hepatitis B virus (HBV) due to chemotherapy. The patient's COVID-19 illness was supposed to be related to her recent medical evaluation. Although being diagnosed with chronic HBV infection for decades, she was not treated with nucleotide analogue and the possibility to preclude HBV reactivation was missed. Moreover, infectious control practices must be draconian in order to save such a fragile population from infections.

Design thinking as a methodological strategy for the economic reactivation of start-ups in Mexico under Covid-19

This chapter presents a methodological and strategic proposal for the application of the design thinking methodology to support the implementation of the work and action plan for the economic reactivation of start-ups in Mexico. The objective is to create a quick reference guide to accelerate start-up resilience. Documentary research is considered on the guidelines and implementation requirements, as well as the measures established by the Mexican Ministry of Health, to mitigate the epidemic caused by the SARS-CoV-2 virus that causes the COVID-19 disease and to carry out an orderly, gradual, and cautious reopening in order to continue caring for people's health in the working environment and at the same time reactivate the start-ups' economy. This chapter provides an alternative guide to direct and propose a structured option for the labour and economic reactivation of start-ups that were considered non-core and that require the completion of regulatory procedures and processes required to obtain the necessary Quick Response code, granted by the entities that regulate the guidelines for the safe reopening of companies. Based on the size of these economic entities, it is considered that they can have between 1 and 10 employees, or no hired personnel at all, which is not considered a priority in the current economic reactivation programmes. A methodological strategy is proposed and implemented to support companies of this size in their immediate process of labour and economic reactivation for a case study of a service company that applied the proposed methodology. © 2022 Emerald Publishing Limited. All rights reserved.

COVID-19 in a patient with Good's syndrome and in 13 patients with common variable immunodeficiency

Antibody deficiencies constitute the majority of primary immunodeficiencies in adults. These patients have a well-established increased risk of bacterial infections but there is a lack of knowledge regarding the relative risks upon contracting COVID-19. In this monocentric study the disease course of COVID-19 in 1 patient with Good's syndrome and in 13 patients with common variable immunodeficiency (CVID) is described. The severity of disease ranged from very mild to severe. Several patients required hospitalization and immunomodulatory treatment but all survived. Although viral infections are not a typical feature of humoral immunodeficiencies we recommend that vigilance is increased in the management of patients with Good's syndrome and CVID during the COVID-19 pandemic.Copyright © 2021

Virtual Educational Intervention of Craftswomen Working with Native Peruvian Cotton during COVID-19 for Reactivating the Artisian Tourism

The pandemic has significantly affected the tourism sector worldwide;however, craftswomen are a vulnerable group that has been affected economically by this crisis. This research evaluated the level of compliance with preventive measures before and after carrying out the virtual educational intervention for craftswomen working with native cotton in the Lambayeque Region, Peru. The methodology applied was a pilot study, quasi-experimental, without a control group. The population consisted of 30 craftswomen from the populated areas of La Raya–Túcume, Pómac III-Pitipo and Jotoro-Jayanca. SPSS Statistics v25 was used for data processing. The χ2 test was used in order to evaluate the variation before and after the intervention. The correlational findings demonstrate that after applying the virtual educational intervention, it is sufficient to apply specific measures in the first (before) and second stage (during) to obtain a higher result in compliance with the general level of the regulations against COVID-19. It is concluded that the virtual educational intervention for the craftswomen has generated awareness, impacting the care of their personal health, their family and their community, as well as being prepared for the reactivation of tourism. © 2023 by the authors.

Viral reactivations and co-infections in COVID-19 patients: a systematic review.

BACKGROUND: Viral reactivations and co-infections have been reported among COVID-19 patients. However, studies on the clinical outcomes of different viral reactivations and co-infections are currently in limit. Thus, the primary purpose of this review is to perform an overarching investigation on the cases of latent virus reactivation and co-infection in COVID-19 patients to build collective evidence contributing to improving patient health. The aim of the study was to conduct a literature review to compare the patient characteristics and outcomes of reactivations and co-infections of different viruses. METHODS: Our population of interest included confirmed COVID-19 patients who were diagnosed with a viral infection either concurrently or following their COVID-19 diagnosis. We extracted the relevant literature through a systematic search using the key terms in the online databases including the EMBASE, MEDLINE, Latin American Caribbean Health Sciences Literature (LILACS), from inception onwards up to June 2022. The authors independently extracted data from eligible studies and assessed the risk of bias using the Consensus-based Clinical Case Reporting (CARE) guidelines and the Newcastle-Ottawa Scale (NOS). Main patient characteristics, frequency of each manifestation, and diagnostic criteria used in studies were summarized in tables. RESULTS: In total, 53 articles were included in this review. We identified 40 reactivation studies, 8 coinfection studies, and 5 studies where concomitant infection in COVID-19 patients was not distinguished as either reactivation or coinfection. Data were extracted for 12 viruses including IAV, IBV, EBV, CMV, VZV, HHV-1, HHV-2, HHV-6, HHV-7, HHV-8, HBV, and Parvovirus B19. EBV, HHV-1, and CMV were most frequently observed within the reactivation cohort, whereas IAV and EBV within the coinfection cohort. In both reactivation and coinfection groups, patients reported cardiovascular disease, diabetes, and immunosuppression as comorbidities, acute kidney injury as complication, and lymphopenia and elevated D-dimer and CRP levels from blood tests. Common pharmaceutical interventions in two groups included steroids and antivirals. CONCLUSION: Overall, these findings expand our knowledge on the characteristics of COVID-19 patients with viral reactivations and co-infections. Our experience with current review indicates a need for further investigations on virus reactivation and coinfection among COVID-19 patients.

A review on the identification of COVID-19, SARS and MERS.

COVID-19 is a global pandemic, which is the third outbreak and epidemic of infectious disease caused by coronavirus in this century and constitutes a major threat to human health.In this paper, COCOVID-19, Severeacute respiratory syndrome (SARS) and Middle East Respiratory syndrome (MERS) were analyzed to distinguish their clinical features, diagnosis, prognosis and prevention, so as to better prevent and treat related diseases.Copyright © 2020 Chinese Medical Association

A review on the identification of COVID-19, SARS and MERS.

COVID-19 is a global pandemic, which is the third outbreak and epidemic of infectious disease caused by coronavirus in this century and constitutes a major threat to human health.In this paper, COCOVID-19, Severeacute respiratory syndrome (SARS) and Middle East Respiratory syndrome (MERS) were analyzed to distinguish their clinical features, diagnosis, prognosis and prevention, so as to better prevent and treat related diseases.Copyright © 2020 Chinese Medical Association