Infections and the Kidney

Global infections are very frequent cause of AKI. Often this is due to the non-specific systemic effects of sepsis and volume depletion and therefore can occur with many infectious agents perhaps most searingly brought to our attention with the SARS-CoV-2 pandemic. The kidney can also be damaged by infections directly involving the renal parenchyma, because of persistent infection elsewhere in the body, as a post-infectious response and secondary diseases causing obstruction. Identifying, first, that kidney injury is due to infection and the particular infection causing the patient's presentation is critical to management. Some infections discussed in this chapter are confined to specific areas of the world, but with increasing global travel and migration, patients may present to healthcare facilities anywhere;thus, a thorough travel history is invaluable. © Springer Nature Switzerland AG 2014, 2022.

Persistent Topological Laplacian Analysis of SARS-CoV-2 Variants

Topological data analysis (TDA) is an emerging field in mathematics and data science. Its central technique, persistent homology, has had tremendous success in many science and engineering disciplines. However, persistent homology has limitations, including its inability to handle heterogeneous information, such as multiple types of geometric objects;being qualitative rather than quantitative, e.g., counting a 5-member ring the same as a 6-member ring, and a failure to describe nontopological changes, such as homotopic changes in protein–protein binding. Persistent topological Laplacians (PTLs), such as persistent Laplacian and persistent sheaf Laplacian, were proposed to overcome the limitations of persistent homology. In this work, we examine the modeling and analysis power of PTLs in the study of the protein structures of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike receptor binding domain (RBD). First, we employ PTLs to study how the RBD mutation-induced structural changes of RBD-angiotensin-converting enzyme 2 (ACE2) binding complexes are captured in the changes of spectra of the PTLs among SARS-CoV-2 variants. Additionally, we use PTLs to analyze the binding of RBD and ACE2-induced structural changes of various SARS-CoV-2 variants. Finally, we explore the impacts of computationally generated RBD structures on a topological deep learning paradigm and predictions of deep mutational scanning datasets for the SARS-CoV-2 Omicron BA.2 variant. Our results indicate that PTLs have advantages over persistent homology in analyzing protein structural changes and provide a powerful new TDA tool for data science. [ FROM AUTHOR] Copyright of Journal of Computational Biophysics & Chemistry is the property of World Scientific Publishing Company and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

IRF2BP2 mutation with autoimmune enteropathy, immune deficiency, and respiratory failure

Case history: We present the case of a 31-year-old Hispanic male with history of recurrent bronchiectasis, invasive aspergillosis, and severe persistent asthma, who is now status post lung transplant for end-stage lung disease. He initially presented at 7 years of age with diarrhea, failure to thrive, and nearly absent immunoglobulin levels (IgG < 33 mg/dL, IgA < 7 mg/dL, IgM = 11 mg/dL, IgE = 4 IU/dL) necessitating IVIG treatment. Small intestinal biopsy showed villous atrophy consistent with autoimmune enteropathy. Sweat chloride was reported as indeterminate (44 me/dL). Initial WBC, platelet, and T- and NK-cell counts were within normal range, and B-cell count and percentage were borderline low. Most recently, he was found to have increased immature B-cell count (CD21low), decreased memory B-cells, and poor pneumococcal vaccine antibody response. Patient has been hospitalized numerous times with increasingly severe bronchiectasis, pneumonitis, and COVID-19 infections twice despite vaccination, leading to respiratory failure and lung transplantation. Family history is negative for immune deficiency and lung diseases. Discussion(s): Of these 3 VUSs (see the table), the one in IRF2BP2 has the most pathogenic potential due to its autosomal dominant inheritance, its location in a conserved domain (Ring), and previous case reports of pathogenic variants at the same or adjacent alleles 1-3. Baxter et al reported a de novo truncating mutation in IRF2BP2 at codon 536 (c.1606CinsTTT), which is similar to our patient's mutation. This patient was noted to have an IPEX-like presentation, with chronic diarrhea, hypogammaglobulinemia, and recurrent infections. Variant Functional Prediction Score for our variant predicts a potentially high damage effect. There are 2 other case reports of heterozygous mutations in loci adjacent to this allele;one (c.1652G>A)2 with a similar clinical phenotype to our patient and the other (C.625-665 del)3 with primarily inflammatory features and few infections. Impact: This case highlights a variant in IRF2BP2 associated with severe hypogammaglobulinemia, recurrent pulmonary infections, and autoimmune enteropathy. [Table presented]Copyright © 2023 Elsevier Inc.

Use of platelet-rich plasma for COVID-19-related olfactory loss: a randomized controlled trial.

INTRODUCTION: The current study evaluated the use of platelet-rich plasma (PRP), an autologous blood product with supraphysiologic concentrations of growth factors, in the treatment of prolonged coronavirus disease 2019 (COVID-19)-related smell loss. METHODS: This multi-institutional, randomized controlled trial recruited patients with COVID-19 who had objectively measured smell loss (University of Pennsylvania Smell Identification Test [UPSIT] ≤ 33) between 6 and 12 months. Patients were randomized to three intranasal injections of either PRP or sterile saline into their olfactory clefts. The primary outcome measure was change in Sniffin' Sticks score (threshold, discrimination, and identification [TDI]) from baseline. The secondary end point measures included responder rate (achievement of a clinically significant improvement, ≥5.5 points TDI), change in individual TDI olfaction scores, and change in subjective olfaction via a visual analog scale. RESULTS: A total of 35 patients were recruited and 26 completed the study. PRP treatment resulted in a 3.67-point (95% CI: 0.05-7.29, p = 0.047) greater improvement in olfaction compared with the placebo group at 3 months and a higher response rate (57.1% vs 8.3%, odds ratio 12.5 [95% exact bootstrap confidence interval, 2.2-116.7]). There was a greater improvement in smell discrimination following PRP treatment compared with placebo but no difference in smell identification or threshold. There was no difference in subjective scores between PRP and placebo. No adverse effects were reported. CONCLUSION: Olfactory function following COVID-19 can improve spontaneously after 6 months and can improve to a greater extent with PRP injection. These data build on the promise of PRP to be a safe potential treatment option for patients with COVID-19-related smell loss, and larger-powered studies will help further assess its efficacy.

The Effects of Arginine-Based Supplements on Fatigue Levels following COVID-19 Infection: A Prospective Study in Romania.

The purpose of this study was to examine the effects of two arginine-based supplements on the fatigue level of patients following the COVID-19 infection. This is a prospective study of the SARS-CoV-2-infected patients divided into two groups (according to family physicians' prescriptions, Group 1 of patients were treated with Astenor Energy® containing arginine aspartate, B6 vitamin, biotin and magnesium, and Group 2 of patients were treated with Astenor Forte® containing L-arginine and malic acid). The patients visited their family physicians from October 2021 to January 2022, complaining of physical and/or mental fatigue following the COVID-19 infection. We recorded 505 patients (146 patients in Group 1 and 359 patients in Group 2) and analyzed the fatigue level using the Fatigue Assessment Scale (FAS) through its total (FAS-T), mental (FAS-M) and physical (FAS-P) scores, at baseline and after three months of treatment. There was no difference between the two groups in terms of age (p = 0.265), but more men were included in Group 1 than in Group 2 (p = 0.001). The patients from Group 2 were significantly more likely to be treated at home than those included in Group 1 (89.7% vs. 65.1%, p < 0.0001) because of the lower severity of the COVID-19 infection (asymptomatic or mild: 82.5% vs. 48.7%, p < 0.0001). After 3 months of treatment, patients indicated no fatigue in the higher percentage compared to than at the baseline (68.7% vs. 27.7%), and the fatigue level significantly decreased both in Group 1 (median baseline 33.0 vs. follow-up 17.00, p < 0.0001) and Group 2 (median baseline 25.0 vs. follow-up 17.00, p < 0.0001). These findings suggest that supplements with L-arginine may be proposed as a remedy to restore physical and mental performance affected by the fatigue burden in people with COVID-19 or following the COVID-19 infection.

Recurrent SARS-CoV-2 mutations in immunodeficient patients.

Long-term severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in immunodeficient patients are an important source of variation for the virus but are understudied. Many case studies have been published which describe one or a small number of long-term infected individuals but no study has combined these sequences into a cohesive dataset. This work aims to rectify this and study the genomics of this patient group through a combination of literature searches as well as identifying new case series directly from the COVID-19 Genomics UK (COG-UK) dataset. The spike gene receptor-binding domain and N-terminal domain (NTD) were identified as mutation hotspots. Numerous mutations associated with variants of concern were observed to emerge recurrently. Additionally a mutation in the envelope gene, T30I was determined to be the second most frequent recurrently occurring mutation arising in persistent infections. A high proportion of recurrent mutations in immunodeficient individuals are associated with ACE2 affinity, immune escape, or viral packaging optimisation. There is an apparent selective pressure for mutations that aid cell-cell transmission within the host or persistence which are often different from mutations that aid inter-host transmission, although the fact that multiple recurrent de novo mutations are considered defining for variants of concern strongly indicates that this potential source of novel variants should not be discounted.

Escherichia coli ST2797 Is Abundant in Wastewater and Might Be a Novel Emerging Extended-Spectrum Beta-Lactamase E. coli.

The increasing prevalence of antibiotic-resistant bacteria is an emerging threat to global health. The analysis of antibiotic-resistant enterobacteria in wastewater can indicate the prevalence and spread of certain clonal groups of multiresistant bacteria. In a previous study of Escherichia coli that were isolated from a pump station in Norway over 15 months, we found a recurring E. coli clone that was resistant to trimethoprim, ampicillin, and tetracycline in 201 of 3,123 analyzed isolates (6.1%). 11 representative isolates were subjected to whole-genome sequencing and were found to belong to the MLST ST2797 E. coli clone with plasmids carrying resistance genes, including blaTEM-1B, sul2, dfrA7, and tetB. A phenotypic comparison of the ST2797 isolates with the uropathogenic ST131 and ST648 that were repeatedly identified in the same wastewater samples revealed that the ST2797 isolates exhibited a comparable capacity for temporal survival in wastewater, greater biofilm formation, and similar potential for the colonization of mammalian epithelial cells. ST2797 has been isolated from humans and has been found to carry extended spectrum ß-lactamase (ESBL) genes in other studies, suggesting that this clonal type is an emerging ESBL E. coli. Collectively, these findings show that ST2797 was more ubiquitous in the studied wastewater than were the infamous ST131 and ST648 and that ST2797 may have similar abilities to survive in the environment and cause infections in humans. IMPORTANCE The incidence of drug-resistant bacteria found in the environment is increasing together with the levels of antibiotic-resistant bacteria that cause infections. The COVID-19 pandemic has shed new light on the importance of monitoring emerging threats and finding early warning systems. Therefore, to mitigate the antimicrobial resistance burden, the monitoring and early identification of antibiotic-resistant bacteria in hot spots, such as wastewater treatment plants, are required to combat the occurrence and spread of antibiotic-resistant bacteria. Here, we applied a PhenePlate system as a phenotypic screening method for genomic surveillance and discovered a dominant and persistent E. coli clone ST2797 with a multidrug resistance pattern and equivalent phenotypic characteristics to those of the major pandemic lineages, namely, ST131 and ST648, which frequently carry ESBL genes. This study highlights the continuous surveillance and report of multidrug resistant bacteria with the potential to spread in One Health settings.

Psychological Treatment of Persistent Genital Arousal Disorder/Genitopelvic Dysesthesia Using an Integrative Approach.

Persistent genital arousal disorder/genitopelvic dysesthesia (PGAD/GPD) is characterized by persistent, unwanted physiological genital arousal (i.e., sensitivity, fullness, and/or swelling) in the absence of sexual excitement or desire which can persist for hours to days and causes significant impairment in psychosocial well-being (e.g., distress) and daily functioning. The etiology and course of PGAD/GPD is still relatively unknown and, unsurprisingly, there are not yet clear evidence-based treatment recommendations for those suffering from PGAD/GPD. We present the case of a 58-year-old woman with acquired persistent genital arousal disorder, which began in March 2020; she believed she developed PGAD/GPD due to a period of significant distress and anxiety related to the COVID-19 pandemic. After seeking medical diagnosis and treatment from multiple healthcare providers and trying a combination of pharmacological and medical treatment modalities, she presented for psychological treatment. An integrative therapy approach (3 assessment sessions, 11 treatment sessions), which included cognitive behavior therapy, distress tolerance and emotion regulation skills from dialectical behavior therapy, and mindfulness practice, was utilized. The patient reported improvements anecdotally (e.g., decreased impact on occupational and social functioning, greater self-compassion, less frequent and shorter duration of PGAD/GPD flare-ups, improved ability to cope with PGAD/GPD symptoms, and decreased need for sleeping medication) and on self-report measures (e.g., lower PGAD/GPD catastrophizing, lower anxiety and depression, and greater overall quality of life).We report the use of an integrative (i.e., psychoeducational, cognitive behavioral, dialectical behavioral, and mindfulness-based) intervention, which may be an effective psychological treatment for PGAD/GPD.

Clustering Analysis Identified Three Long COVID Phenotypes and Their Association with General Health Status and Working Ability.

BACKGROUND/AIM: This study aimed to distinguish different phenotypes of long COVID through the post-COVID syndrome (PCS) score based on long-term persistent symptoms following COVID-19 and evaluate whether these symptoms affect general health and work ability. In addition, the study identified predictors for severe long COVID. METHOD: This cluster analysis included cross-sectional data from three cohorts of patients after COVID-19: non-hospitalized (n = 401), hospitalized (n = 98) and those enrolled at the post-COVID outpatient's clinic (n = 85). All the subjects responded to the survey on persistent long-term symptoms and sociodemographic and clinical factors. K-Means cluster analysis and ordinal logistic regression were used to create PCS scores that were used to distinguish patients' phenotypes. RESULTS: 506 patients with complete data on persistent symptoms were divided into three distinct phenotypes: none/mild (59%), moderate (22%) and severe (19%). The patients with severe phenotype, with the predominating symptoms were fatigue, cognitive impairment and depression, had the most reduced general health status and work ability. Smoking, snuff, body mass index (BMI), diabetes, chronic pain and symptom severity at COVID-19 onset were factors predicting severe phenotype. CONCLUSION: This study suggested three phenotypes of long COVID, where the most severe was associated with the highest impact on general health status and working ability. This knowledge on long COVID phenotypes could be used by clinicians to support their medical decisions regarding prioritizing and more detailed follow-up of some patient groups.

Analysis of Spatial and Spatiotemporal Anomalies Using Persistent Homology: Case Studies with COVID-19 Data

We develop a method for analyzing spatial and spatiotemporal anomalies in geospatial data using topological data analysis (TDA). To do this, we use persistent homology (PH), which allows one to algorithmically detect geometric voids in a data set and quantify the persistence of such voids. We construct an efficient filtered simplicial complex (FSC) such that the voids in our FSC are in one-to-one correspondence with the anomalies. Our approach goes beyond simply identifying anomalies;it also encodes information about the relationships between anomalies. We use vineyards, which one can interpret as time-varying persistence diagrams (which are an approach for visualizing PH), to track how the locations of the anomalies change with time. We conduct two case studies using spatially heterogeneous COVID-19 data. First, we examine vaccination rates in New York City by zip code at a single point in time. Second, we study a year-long data set of COVID-19 case rates in neighborhoods of the city of Los Angeles.

Persistent Symptoms of Severe and Critical COVID‑19: A Cross‑Sectional Study after more than 120 Days from Disease Onset

Objective: The objective of this study is to assess the prevalence and predictors of symptom persistence associated with severe and critical coronavirus disease-2019 (COVID-19) after more than 120 days from the onset of the disease. Materials and Methods: This is a single-center, cross-sectional study of 125 adults who were admitted to King Khalid University Hospital (Riyadh, Saudi Arabia) with severe and critical COVID-19 between March 4 and December 1, 2020. Telephone interviews were conducted between April 1 and May 31, 2021, to collect data on COVID-19 symptoms persisting after more than 120 days from the onset of the disease. All of the participants had been discharged from the hospital and had resumed their normal lives. Symptoms of COVID-19 that had not been present before the onset of the disease were considered to be persistent if participants confirmed their continued presence at the time of the interview. The impact of chronic disease on persistent symptoms was considered. Results: About 42.4% (53/125) of patients had at least one or more persistent symptoms;27.2% (34/125) had breathlessness, 5.6% (7/125) cough, and 4.8% (6/125) chest pain. These three symptoms had been present from the first presentation. Hair loss was reported by 14.4% (18/125), forgetfulness by 8% (10/125), difficulty in concentrating by 6.4% (8/125), and lack of energy by 4% (5/125). Those had manifested after more than 120 days from the symptom's onset. The major factors in suffering from persistent symptoms were intensive care unit (ICU) admission or/and fever (temperature >38°), or/and diarrhea. There was no correlation between persistent symptoms and chronic diseases. Conclusions: After more than 120 days from the confirmation of severe and critical COVID-19, more than one-third of discharged adults were found to have one or more persistent symptoms. These were mainly associated with the need for ICU admission, fever (temperature >38°), and diarrhea. More care needs to be given to COVID-19 patients in the presence of these factors and prolonged medical care would appear to be essential. © 2023 Journal of Nature and Science of Medicine ;Published by Wolters Kluwer - Medknow.

Study of emergency supplies based dispatch in a persistent epidemic

The continued outbreak of the novel coronavirus pneumonia (COVID-19) has had a huge impact on people's lives. In the context of the ongoing epidemic and the limited distribution capacity due to the multi-regional epidemic closure, it has become an urgent reality to minimise the damage caused to people's daily lives under the epidemic and other emergencies, and to implement safe, fair and economical dispatch of emergency supplies for the epidemic area. The problem. Based on this, a mixed integer linear programming model is constructed to maximise the fairness and minimise the transportation cost of emergency material dispatch. © 2023 SPIE.

COVID-19 perseverative cognition and depressive symptoms in Hong Kong: The moderating role of resilience, loneliness and coping strategies.

BACKGROUND: The COVID-19 pandemic significantly increased depression prevalence in general population. However, the relationship between persistent dysfunctional thinking associated with COVID-19 (perseverative-cognition) and depression, and its potential moderators are understudied. We aimed to examine the association between COVID-19 perseverative-cognition and depression, and the moderating effect of potential risk and protective factors on this association in general public during the peak of fifth COVID-19 wave in Hong Kong. METHODS: This survey recruited 14,269 community-dwelling adults between March 15-April 3, 2022 to investigate association between COVID-19 perseverative-cognition and depression, and the moderating effect of resilience, loneliness and three coping strategies (including emotion-focused, problem-focused and avoidant coping) on this association, using hierarchical regression models and simple slope analyses. COVID-19 perseverative cognition was assessed by the Obsession with COVID-19 Scale (OCS) and depressive symptoms were measured by the Patient Health Questionnaire-9 (PHQ-9). RESULTS: Perseverative-cognition was positively associated with depression severity. Resilience, loneliness and three coping strategies moderated the association between perseverative-cognition and depression. Specifically, greater resilience and emotion-focused coping ameliorated the association between perseverative-cognition and depression, while higher levels of loneliness, avoidant and problem-focused coping accentuated such association. LIMITATIONS: Cross-sectional design precluded establishing causality among variables. CONCLUSION: This study affirms that COVID-19 perseverative-cognition is significantly related to depression. Our findings indicate the potential critical role of enhanced personal resilience and social support, and adoption of emotion-focused coping in mitigating negative effect of COVID-19 related maladaptive thinking on depression severity, thereby facilitating development of targeted strategies to reduce psychological distress amidst the prolonged pandemic.

Adopting a Telemedicine Model of Asthma Care during the Covid-19 Pandemic

Purpose of study The IMPACT DC Asthma Clinic is an intervention program designed to transition children who are heavily dependent on the emergency department for episodic care to more effective longitudinal asthma care in their primary medical homes. We sought to study the implementation of a telemedicine model for IMPACT DC during the COVID-19 pandemic in order to address barriers to care. Methods used A telemedicine model of IMPACT DC was implemented using rapid-cycle improvements and process mapping. Measures for adoption of services including visit completion, show rates, primary language, and patient satisfaction were collected for six months. Healthcare utilization data for the six months prior to the IMPACT DC clinical intervention was collected. This data was compared to in- person clinic visits over the same six-month period the previous year. Summary of results 360 patients successfully completed a telemedicine visit between April 2020 and September 2020 with an average visit show rate of 52%. Primary language was English in 89%. These patients were most frequently classified as having mild-persistent asthma and were assessed as well-controlled. Satisfaction survey response rate was 33%;overall average satisfaction was high. In the comparison group, 701 patients successfully completed an in-person clinic visit between April 2019 and September 2019 with a visit show rate of 39%. Primary language was English in 84%. These patients were most frequently classified as having mild-persistent asthma, not well-controlled. Healthcare utilization data for both groups six months prior to their visit are displayed Conclusions The use of telemedicine provides IMPACT DC a feasible and adoptable model to continue caring for children with asthma, with overall high patient satisfaction. This model addresses access barriers during the pandemic, and promises to be an adjunctive tool for reaching families with low show rates and high healthcare utilization. (Table Presented).

Diazoxide in the Treatment of Asymptomatic Refractory Hypoglycemia in End Stage Renal Disease

Introduction: Diabetic patients with end-stage renal disease (ESRD) treated with insulin or any other diabetic agent show high variations in their glucose metabolism, lower insulin clearance level, and uncertain accuracy of glycemic control measurements. Therefore, these patients are at a greater risk of developing hypoglycemia. Diazoxide use in the treatment of spontaneous and refractory hypoglycemia in this population has not been well documented. We report a case of a young diabetic male that has been successfully treated with diazoxide for his asymptomatic refractory hypoglycemic episodes. Case Description: A young man with type 2 diabetes mellitus complicated by diabetic nephropathy, on hemodialysis for ESRD, presented with shortness of breath due to COVID pneumonia. After resolution of his infection, he was noted to have recurrent asymptomatic hypoglycemic episodes, although he has been off his diabetes medications for the past few years due to worsening of his kidney function. His oral intake was adequate and there was no concern for malnutrition, or any substance use. From the testing performed, we were able to exclude exogenous insulin or insulin secretagogues use and the presence of insulin antibodies. Insulin and noninsulin (insulin-like growth factor) mediated mechanisms were also ruled out. Since he was having recurrent and refractory asymptomatic hypoglycemic episodes and to minimize the need for supplemental dextrose containing fluids, he was started on diazoxide at 3 mg/kg/day. Knowing the risk of fluid retention with diazoxide, this patient on hemodialysis tolerated it well. Diazoxide helped reduce his episodes of hypoglycemia and he was then safely discharged on it. Discussion(s): In ESRD, hypoglycemia can be explained by the impaired contribution of the kidneys to gluconeogenesis and glucose release, as well as the higher insulin levels caused by insulin resistance and decrease in insulin clearance. When his hypoglycemia persisted even after the resolution of his infection, further testing and work-up was done and other causes of hypoglycemia were ruled out. Generally, diazoxide is used as a treatment to manage the symptoms of hypoglycemia in congenital hyperinsulinism, insulinomas and post bariatric surgery cases of hyperinsulinemic hypoglycemia. However, it has not been the optimal treatment when it comes to treating hypoglycemia in ESRD patients because of its side effects;specifically, fluid retention, and electrolyte imbalances. In our case, the patient was treated with diazoxide as a last resort, despite its known side effects and the limited documentation of its use in ESRD patients. Actually, a few other case reports, have also shown promising results with the use of diazoxide for that purpose with no or minimal side effects. However, there are not enough studies that have shown the benefits or risks of long-term treatment of diazoxide in ESRD patients, an area of growing interest.Copyright © 2023

Zooanthropogenic potential of SARS-CoV-2 virus: Implications for vaccine-mediated immunity

The human pandemic caused by Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that started in December, 2019 is still continuing in various parts of the world. The SARS-CoV-2 has evolved through sporadic mutations and recombination events and the emergence of alternate variants following adaptations in humans and human-to-animal transmission (zooanthraponosis) has raised concerns over the efficacy of vaccines against new variants. The animal reservoir of SARS-CoV-2 is unknown despite reports of SARS-CoV- 2-related viruses in bats and pangolins. A recent report of back-andforth transmission of SARS-CoV-2 between humans and minks on mink farms in the Netherlands has sparked widespread interest in zooanthroponotic transmission of SARS-CoV-2 followed by reemergence to infect human populations. The risk of animal to human transmission depends on virus-host interaction in susceptible species that may be short-term or long term risks. The short term risk might be due to infection to humans during the viremic stage in susceptible animals. The long term risk might be either due to persistence of the virus at population level or latency of infection leading to risk of evolution and re-emergence of the virus. Experimental studies have identified a range of animals that are susceptible and permissive to SARS-CoV-2 infection viz. cats, ferrets, hamsters, mink, non-human primates, tree shrews, raccoon dogs, fruit bats, and rabbits. The health impacts of SARS-CoV-2 infection in animals are unknown and it is likely that other susceptible species have not been discovered yet. Apart from farmed animals, stray cats and rodents have been identified as a potential opportunity for ongoing transmission in intense farming situations. Recognizing animal species that are most susceptible to infection is the first step in preventing ongoing transmission from humans. Minimizing the risk of zooanthraponosis requires multi-sectoral coordination that includes implementation of strict biosecurity measures such as controlled access to farms that house susceptible animals, bio-secure entry and exit protocols, disinfection protocols in farm, down time for animal transport vehicles and daily assessments of human handlers for exposure to SARS-CoV- 2. Hence, active surveillance in animal species that are prioritized based on risk assessment need to be initiated in coordination with health and environment sectors for early identification of emerging and re-emerging variants of SARS-CoV-2 virus in animals.

An Effective Threat Detection Framework for Advanced Persistent Cyberattacks

Recently, with the normalization of non-face-to-face online environments in response to the COVID-19 pandemic, the possibility of cyberattacks through endpoints has increased. Numerous endpoint devices are managed meticulously to prevent cyberattacks and ensure timely responses to potential security threats. In particular, because telecommuting, telemedicine, and tele-education are implemented in uncontrolled environments, attackers typically target vulnerable endpoints to acquire administrator rights or steal authentication information, and reports of endpoint attacks have been increasing considerably. Advanced persistent threats (APTs) using various novel variant malicious codes are a form of a sophisticated attack. However, conventional commercial antivirus and anti-malware systems that use signature-based attack detection methods cannot satisfactorily respond to such attacks. In this paper, we propose a method that expands the detection coverage in APT attack environments. In this model, an open-source threat detector and log collector are used synergistically to improve threat detection performance. Extending the scope of attack log collection through interworking between highly accessible open-source tools can efficiently increase the detection coverage of tactics and techniques used to deal with APT attacks, as defined by MITRE Adversarial Tactics, Techniques, and Common Knowledge (ATT&CK). We implemented an attack environment using an APT attack scenario emulator called Carbanak and analyzed the detection coverage of Google Rapid Response (GRR), an open-source threat detection tool, and Graylog, an open-source log collector. The proposed method expanded the detection coverage against MITRE ATT&CK by approximately 11% compared with that conventional methods. © 2023 Tech Science Press. All rights reserved.

Somatic Cough Syndrome, Is COVID-19 Guilty: Case Reports and Literature Review

Introduction: Somatic cough syndrome (formerly known as Psychogenic Cough) is an uncommon and sometimes underestimated cause of persistent cough that is generally found after a series of rigorous testing and therapies. There is a peak incidence between 8 and 14 years;both sexes are affected similarly. Case presentation: The current article describes three cases of somatic cough disorder observed at our institution during the COVID-19 pandemic. The patients were diagnosed after 2-3 months and were successfully managed with suggestive and behavioral therapy. Conclusion(s): Lack of knowledge regarding somatic cough syndrome exists among frontline health care personnel. The relevance of reporting such cases emphasizes the need for health care professionals to be aware of the need to avoid unneeded medical management. Whether or not COVID-19 is linked to an increased incidence of somatic cough syndrome is yet to be established. Still, multidisciplinary collaboration, patient participation, and public education are essential, along with a clear case definition or working diagnosis.Copyright © 2023, Bahrain Medical Bulletin. All rights reserved.

Factors associated with oxygen requirement and persistent symptoms 1 year after severe COVID-19 infection.

OBJECTIVE: We aimed to describe the prevalence and factors associated with the need for supplemental oxygen and persistent symptoms 1 year after severe SARS-CoV-2 infection. METHODS: In this historical cohort and nested case-control study, we included adults with severe COVID-19 (requiring admission to the intensive care unit or invasive mechanical ventilation). We evaluated factors associated with a need for supplemental oxygen and persistent symptoms 1 year after severe infection. RESULTS: We included 135 patients (median age 62 years, 30% women). At 1-year follow-up, the main symptoms were dyspnea (32%), myalgia (9%), cough (7%), anxiety (4%), and depression (5%); 12.59% of patients had prolonged requirement for supplemental oxygen. Factors associated with a persistent requirement for supplemental oxygen were female sex (odds ratio 3.15, 95% confidence interval 1.11-8.90) and Charlson Comorbidity Index > 4 (odds ratio 1.60, 95% confidence interval 1.20-2.12). CONCLUSIONS: We found that a high prevalence of supplemental oxygen requirement 1 year after severe COVID infection was associated with female sex and a baseline high rate of comorbidities. It is unknown whether this prevalence was related to other factors, such as the altitude at which patients lived. More than half of patients had prolonged post-COVID syndrome.