Serological Profile of SARS-CoV-2 in Unvaccinated Blood Donors: A Nationwide Study During the Fifth Wave of the Pandemic in Iran

Background: Serological studies can demonstrate pathogen circulation in regional populations and reflect public health mea-sures' effectiveness during different pandemic phases. By late November 2021, coinciding with the third pandemic wave, the sero-prevalence of SARS-CoV-2 spike IgG antibodies among the Iranian population was 32.63%. Objective(s): This study aimed to assess the Iranian population's seroprevalence during the fifth pandemic wave by analyzing donated blood samples. Method(s): This population-based cross-sectional study was conducted on Iranian blood donors referred to all 31 main provincial capitals between August 2021 and September 2021. The participants selected through quota sampling were asked to complete a questionnaire on socio-demographics and coronavirus disease 2019 (COVID-19)-related information. Also, SARS-CoV-2 spike IgG antibodies were measured in serum samples using SARS-CoV-2 enzyme-linked immunosorbent assay (ELISA) kits. The seroprevalence was weighted based on the gender and age groups of the population and then adjusted for test performance. Result(s): Totally 3,339 blood donors participated in this study. The overall population-weighted seroprevalence adjusted for test performance was 52.67% (95% confidence interval (CI): 50.14-55.21). Seroprevalence was higher among participants with a high school diploma (55.45%, 95% CI 50.61-60.29), a positive history of close contact with COVID-19 patients (65.23%, 95% CI 60.83-69.63), and previous positive COVID-19 PCR tests (86.51%, 95% CI 82.32-90.7). Conclusion(s): More than half of the study population was exposed to SARS-CoV-2, indicating a 1.7-fold increase in the seroprevalence between late November 2020 and mid-September 2021. Our finding illuminated the pattern of Iran's fifth wave of the pandemic.Copyright © 2023, Author(s).

SARS-CoV-2 seroprevalence among blood donors in Uganda: 2019-2022.

BACKGROUND: The true burden of COVID-19 in low- and middle-income countries remains poorly characterized, especially in Africa. Even prior to the availability of SARS-CoV-2 vaccines, countries in Africa had lower numbers of reported COVID-19 related hospitalizations and deaths than other regions globally. METHODS: Ugandan blood donors were evaluated between October 2019 and April 2022 for IgG antibodies to SARS-CoV-2 nucleocapsid (N), spike (S), and five variants of the S protein using multiplexed electrochemiluminescence immunoassays (MesoScale Diagnostics, Rockville, MD). Seropositivity for N and S was assigned using manufacturer-provided cutoffs and trends in seroprevalence were estimated by quarter. Statistically significant associations between N and S antibody seropositivity and donor characteristics in November-December 2021 were assessed by chi-square tests. RESULTS: A total of 5393 blood unit samples from donors were evaluated. N and S seropositivity increased throughout the pandemic to 82.6% in January-April 2022. Among seropositive individuals, N and S antibody levels increased ≥9-fold over the study period. In November-December 2021, seropositivity to N and S antibody was higher among repeat donors (61.3%) compared with new donors (55.1%; p = .043) and among donors from Kampala (capital city of Uganda) compared with rural regions (p = .007). Seropositivity to S antibody was significantly lower among HIV-seropositive individuals (58.8% vs. 84.9%; p = .009). CONCLUSIONS: Despite previously reported low numbers of COVID-19 cases and related deaths in Uganda, high SARS-CoV-2 seroprevalence and increasing antibody levels among blood donors indicated that the country experienced high levels of infection over the course of the pandemic.

Covid-19 in Patients Presenting with Malaria-Like Symptoms at the Korle Bu Polyclinic, Accra

Intro: Malaria is one of Ghana's most frequent illnesses and the most common cause of febrile sickness. Most infectious diseases including COVID-19 and arboviral infections mimic malaria due to the overlapping of non-specific symptoms they both share.This study investigated COVID-19 in patients presenting with malaria-like symptoms at the Korle Bu Polyclinic, Accra. Method(s): This study enrolled 300 patients presenting with malaria-like symptoms aged <= 18. After consent was obtained from study patients, two to three millilitres of whole blood, nasopharyngeal and oropharyngeal swab samples was collected for screening of Plasmodium falciparum using malaria rapid diagnostic test, microscopy and nested PCR and SARS-CoV-2 using SARSCoV-2 antigen test and Real-time PCR respectively. The whole blood sample was also used for COVID-19 antibody test and full blood count using hematological analyser. Finding(s): The detection of SARS-CoV-2 by COVID-19 Rapid Antigen Test and Real-time PCR were 60/300 (20%) and 26/300 (8.7%) respectively. Delta variant was reported in most SARS-CoV-2 positives with CT values below 30. The prevalence of malaria by microscopy, RDT and nested PCR were 7/300 (2.3%), 7/300 (2.3%) and 8/300 (2.7%) respectively. The most common symptom experienced by the study patients at the polyclinic was headache (95%;57/60). Comorbidities reported were hypertension, diabetes, Asthma, hypertension and diabetes. Most of the study patients had been previously exposure to SARS CoV-2 (113/300) and 66.7% (34/51) of AstraZeneca vaccinated patients had no antibody. Conclusion(s): Due to the synergy of symptoms, screening for COVID-19 in patients presenting with malaria-like symptoms is vital for immediate diagnosis and treatment.Copyright © 2023

Seroprevalence of antibodies against SARS-CoV-2 in the Valencian Community (Spain) as of October 2022.

OBJECTIVE: To estimate the seroprevalence of SARS-CoV-2 antibodies in the Valencian Community (Spain) in October 2022, when BA.5 was the predominant variant. METHOD: Cross-sectional, region-wide, population-based serosurvey study in 88 randomly selected primary care centers of the Valencian Community. RESULTS: Seroprevalence of anti-nucleocapsid (indicative of past infection) and total receptor binding domain (indicative of past infection or vaccination) antibodies was 71.0% (confidence interval [CI]: 67.8-74.2) and 98.4% (CI: 97.5-99.3), respectively. 66.7% (CI: 63.4-70.0) of the population shows hybrid immunity, but only 43.2% in those 80 and over. CONCLUSIONS: The high proportion of hybrid immunity detected is relevant for public health strategies. A second vaccination booster was advisable in the elderly population.

Advancements in COVID- 19 Testing: An in-depth overview.

COVID-19 rapidly evolved as a pandemic, killing and hospitalising millions of people, creating unprecedented hurdles for communities and health care systems worldwide. The rapidly evolving pandemic prompted the head of the World Health Organisation to deliver a critical message: "test, test, test." The response from the diagnostic industry and researchers worldwide was overwhelming, resulting in more than a thousand commercial tests available in the market worldwide. Several sampling approaches and diagnostic techniques have been employed from the early stages of the pandemic, such as SARS-CoV-2 detection by targeting the viral RNA or protein, indirectly via antibody testing, biochemical estimation, and various imaging techniques, and many are still in the various stages of development and yet to be marketed. Accurate testing techniques and appropriate sampling are the need of the hour to manage, diagnose and treat the pandemic, especially in the current crisis, where SARS-CoV-2 undergoes constant mutation, evolving into various strains, which are pretty challenging. The article discusses various testing techniques as well as screening methods for detection, treatment, and management of COVID-19 transmission, such as NAAT, PCR, isothermal detection including RT-LAMP, RPA, NASBA, RCA, SDA, NEAR, and TMA, CRISPR strategy, nanotechnology approach, metagenomic profiling, point of care tests, virus neutralization test, ELISA, biomarker estimation, utilization of imaging techniques such as CT, ultrasonography, brain MRI in COVID-19 complications, and other novel strategies including microarray methods, microfluidic methods and artificial intelligence with an emphasis on advancements in the testing strategies for the diagnosis, management, and prevention of COVID-19.

SARS CoV-2 seroprevalence and diagnostic accuracy during a COVID-19 outbreak in a major penitentiary complex in Brazil, June to July 2020

PurposeThis study aims to estimate the overall SARS-CoV-2 seroprevalence and evaluate the accuracy of an antibody rapid test compared to a reference serological assay during a COVID-19 outbreak in a prison complex housing over 13,000 prisoners in Brasília.Design/methodology/approachThe authors obtained a randomized, stratified representative sample of each prison unit and conducted a repeated serosurvey among prisoners between June and July 2020, using a lateral-flow immunochromatographic assay (LFIA). Samples were also retested using a chemiluminescence enzyme immunoassay (CLIA) to compare SARS-CoV-2 seroprevalence and 21-days incidence, as well as to estimate the overall infection fatality rate (IFR) and determine the diagnostic accuracy of the LFIA test.FindingsThis study identified 485 eligible individuals and enrolled 460 participants. Baseline and 21-days follow-up seroprevalence were estimated at 52.0% (95% CI 44.9–59.0) and 56.7% (95% CI 48.2–65.3) with LFIA;and 80.7% (95% CI 74.1–87.3) and 81.1% (95% CI 74.4–87.8) with CLIA, with an overall IFR of 0.02%. There were 78.2% (95% CI 66.7–89.7) symptomatic individuals among the positive cases. Sensitivity and specificity of LFIA were estimated at 43.4% and 83.3% for IgM;46.5% and 91.5% for IgG;and 59.1% and 77.3% for combined tests.Originality/valueThe authors found high seroprevalence of anti-SARS-CoV-2 antibodies within the prison complex. The occurrence of asymptomatic infection highlights the importance of periodic mass testing in addition to case-finding of symptomatic individuals;however, the field performance of LFIA tests should be validated. This study recommends that vaccination strategies consider the inclusion of prisoners and prison staff in priority groups.

Atrio-Ventricular Conduction Abnormalities in Multisystem Inflammatory Syndrome in Children

Purpose of study Since mid-April 2020 in Europe and North America, clusters of pediatric cases with a newly described severe systemic inflammatory response with shock have appeared. Patients had persistent fevers >38.5 C, hypotension, features of myocardial dysfunction, coagulopathy, gastrointestinal symptoms, rash, and elevated inflammatory markers without other causes of infection. The World Health Organization, Centers for Disease Control, and Royal College of Paediatrics associated these symptoms with SARS-CoV-2 as multisystem inflammatory syndrome in children (MIS-C). Cardiac manifestations include coronary artery aneurysms, left ventricular systolic dysfunction evidenced by elevation of troponin-T (TnT) and pro-B-type naturietic peptide (proBNP), and electrocardiogram (ECG) abnormalities. We report the clinical course of three children with MIS-C while focusing on the unique atrioventricular (AV) conduction abnormalities. Case #1:19-year-old previously healthy Hispanic male presented with abdominal pain, fever, and non-bloody diarrhea for three days. He was febrile and hypotensive (80/47 mmHg) requiring fluid resuscitation. Symptoms, lab findings, and a positive COVID-19 antibody test were consistent with MIS-C. Methylprednisolone, intravenous immunoglobulin (IVIG), and enoxaparin were started. He required epinephrine for shock and high flow nasal cannula for respiratory distress. Initial echocardiogram demonstrated a left ventricular ejection fraction (LVEF) of 40% with normal appearing coronaries. Troponin and proBNP were 0.41 ng/mL and proBNP 15,301 pg/mL respectively. ECG showed an incomplete right bundle branch block. He eventually became bradycardic to the 30s-50s and cardiac tracing revealed a complete AV block (figure 1a). Isoproterenol, a B1 receptor agonist, supported the severe bradycardia until the patient progressed to a type 2 second degree AV block (figure 1b). A second dose of IVIG was administered improving the rhythm to a type 1 second degree AV block. An IL-6 inhibitor, tocilizumab was given as the rhythm would not improve, and the patient soon converted to a first-degree AV block. Cardiac magnetic resonance imaging showed septal predominant left ventricular hypertrophy and subepicardial enhancement along the basal inferior/anteroseptal walls typical for myocarditis. Case #2: 9-year-old previously healthy Hispanic male presented after three days of daily fevers, headaches, myalgias, diffuse abdominal pain, and ageusia. He was febrile, tachycardic, and hypotensive (68/39 mmHg). Hypotension of 50s/20s mmHg required 3 normal saline boluses of 20 ml/kg and initiation of an epinephrine drip. Severe hypoxia required endotracheal intubation. After the MIS-C diagnosis was made, he was treated with IVIG, mehtylprednisolone, enoxaparin, aspirin, and ceftriaxone. Due to elevated inflammatory markers by day 4 and patient's illness severity, a 7-day course of anakinra was initiated. Initial echocardiogram showed mild tricuspid and mitral regurgitation with a LVEF of 35-40%. Despite anti-inflammatory therapy, troponin and proBNP were 0.33 ng/mL and BNP of 25,335 pg/mL. A second echocardiogram confirmed poor function so milrinone was started. Only, after two doses of anakinra, LVEF soon normalized. Despite that, he progressively became bradycardic to the 50's. QTc was prolonged to 545 ms and worsened to a max of 592 ms. The aforementioned therapies were continued, and the bradycardia and QTc improved to 405 ms. Patient #3: 9-year-old African American male presented with four days of right sided abdominal pain, constipation, and non-bilious non-bloody emesis. He had a negative COVID test and unremarkable ultrasound of the appendix days prior. His history, elevated inflammatory markers, and positive COVID- 19 antibody were indicative of MIS-C. He was started on the appropriate medication regimen. Initial ECG showed sinus rhythm with normal intervals and echocardiogram was unremarkable. Repeat imaging by day three showed a decreased LVEF of 50%. ECG had since changed to a right bundle branch block. Anakinra as started and steroid dosing was increased. By day 5, he became bradycardic to the 50s and progressed to a junctional cardiac rhythm. Cardiac function normalized by day 7, and anakinra was subsequently stopped. Thereafter, heart rates ranged from 38-48 bpm requiring transfer to the pediatric cardiac intensive care unit for better monitoring and potential isoproterenol infusion. He remained well perfused, with continued medical management, heart rates improved. Methods used Retrospective Chart Review. Summary of results Non-specific T-wave, ST segment changes, and premature atrial or ventricular beats are the most often noted ECG anomalies. All patients initially had normal ECGs but developed bradycardia followed by either PR prolongation or QTc elongation. Two had mild LVEF dysfunction prior to developing third degree heart block and/or a junctional escape rhythm;one had moderate LVEF dysfunction that normalized before developing a prolonged QTc. Inflammatory and cardiac markers along with coagulation factors were the highest early in disease course, peak BNP occurred at approximately hospital day 3-4, and patient's typically had their lowest LVEF at day 5-6. Initial ECGs were benign with PR intervals below 200 milliseconds (ms). Collectively the length of time from initial symptom presentation till when ECG abnormalities began tended to be at day 8-9. Patients similarly developed increased QTc intervals later in the hospitalization. When comparing with the CRP and BNP trends, it appeared that the ECG changes (including PR and QTc elongation) occurred after the initial hyperinflammatory response. Conclusions Although the mechanism for COVID-19 induced heart block continues to be studied, it is suspected to be secondary to inflammation and edema of the conduction tissue. Insufficiency of the coronary arterial supply to the AV node and rest of the conduction system also seems to play a role. Although our patients had normal ECG findings, two developed bundle branch blocks prior to more complex rhythms near the peak of inflammatory marker values. Based on the premise that MIS-C is a hyperinflammatory response likely affecting conduction tissue, our group was treated with different regimens of IVIG, steroids, anakinra, and/or tocilizumab. Anakinra, being an IL-1 inhibitor, has been reported to dampen inflammation in viral myocarditis and tocilizumab has improved LVEF in rheumatoid arthritis patients. Based on our small case series, patient's with MISC can have AV nodal conduction abnormalities. The usual cocktail of IVIG and steroids helps;however, when there are more serious cases of cardiac inflammation, adjuvant immunosuppresants like anakinra and toculizumab can be beneficial. (Figure Presented).

COVID-19 pandemic response in the Meuse-Rhine Euroregion: methods, participation and recommendations of a longitudinal cross-border study.

BACKGROUND: Comparative data collection in transborder areas can contribute to informed decision making processes when dealing with borderless health threats such as pandemics, and thus help minimize the negative health effects for its citizens. To examine the pandemic response over time and the impact of infectious disease control in a cross-border setting, a prospective longitudinal study was conducted in the border area between Germany, Belgium and the Netherlands. In the spring of 2021, a random sample of 26,925 adult citizens selected from governmental registries was invited to collect a blood sample at home for SARS-CoV-2 antibody testing and to fill in an online questionnaire on attitudes and behaviour towards infection prevention measures, cross-border mobility, social network and support, COVID-19 self-reported infection(s) and symptoms, vaccination, general self-reported health and socio-demographics. In autumn 2021, participants were invited for a follow-up round. An online tool was developed to coordinate fieldwork procedures, real-time monitoring of participation and consultation of antibody test results. Furthermore, a helpdesk in all three languages for participants' support was set up. RESULTS: In the first round, 6,006 citizens in the Meuse-Rhine Euroregion participated. 15.3% of the invited citizens on the Belgian side of the border participated. In the Netherlands and Germany this was respectively 27% and 23.7%. In the follow-up round 4,286 (71.4%) citizens participated for the second time. The participation rate was highest in the age group 50-69 years and lowest in > 80 in all sub regions of the Meuse-Rhine Euroregion. More women participated than men. Overall, more blood samples were returned than completed questionnaires. In total, 3,344 citizens in the Meuse-Rhine Euroregion completed all components of participation in both rounds. CONCLUSIONS: The collection of comparative data can help better assess the pandemic response and the impact of infectious disease control in a cross-border area. Recommendations for a longitudinal cross-border study include a centralized online environment, mapping out potential challenges related to national regulations in the preparation phase and organizing regional coordination centres to create more familiarity and trust towards the involved organisations.

Adults with congenital heart disease and COVID-19

Background: Adults with congenital heart disease (ACHD) are considered at increased risk for complications due to COVID-19, especially in those with cyanosis or heart failure. However, data regarding the rate of infection as well as regarding a myocardial involvement of a COVID-19 infection in ACHD patients are currently lacking. Purpose(s): To study the rate of COVID-19 infections in ACHD patients from a tertiary centre as well as the rate of myocardial involvement of a COVID- 19 infection. Method(s): All consecutive ACHD patients (over the age of 18 years) who attended the outpatient clinic of a tertiary centre from January 2021 to June 2021 were eligible to participate. Demographic data, as well as medical/ surgical data including a history of a COVID-19 infection were collected. All patients had an antibody test for COVID-19. Patients with a positive antibody test were offered cardiovascular magnetic resonance imaging (CMR). Result(s): Altogether, 420 patients (44.8% female, mean age 36.4+/-11.6 years) were included in the study. Congenital heart defect (CHD) complexity according to the Bethesda classification was simple in 96 (22.9%), moderate in 186 (44.3%), complex in 117 (27.9%), and miscellaneous in 21 (5.0%) patients. A positive antibody test for COVID-19 was present in 28 (6.7%) patients (CHD complexity: Simple n=5, moderate n=14, severe n=7, miscellaneous n=2). Out of these 28 patients, 14 had no symptoms at all. Those with symptoms had mainly mild symptoms and were all managed in the outpatient setting. While 11 patients (39.3%) were not at all aware of their infection, 17 already knew that they had COVID-19. There was no significant difference between ACHD patients with a positive test vs those with a negative test regarding age, gender, New York Heart Association class, or complexity of CHD. Out of the 28 patients with a positive antibody test, 14 agreed to a CMR. A myocardial involvement, i.e. signs of active or healed myocarditis, was not present in any of these. Conclusion(s): In this single-centre study, 6.7% of ACHD patients attending the outpatient clinic had positive antibodies for COVID-19. Out of these, 50% were asymptomatic and 39.3% were not aware of their infection. A myocardial involvement was not found in any of the patients that underwent a CMR. These results indicate a large number of undetected cases of COVID-19 in the ACHD population and offer reassurance that in the vast majority of cases the infection has a mild course.

Hacettepe Health Cohort (HU-CoVaCS): Study Design, Baseline Characteristics and the First 3-Month-Follow Up of COVID-19 Vaccinated Students.

Objective: This study included participants from Hacettepe University 4th, 5th, and 6th-grade students of Medical School and 4th and 5th-grade students of Dental School;and aimed to evaluate the general health status, COVID-19 history, vaccination status, and SARS-CoV-2 antibody levels of the participants to support their physical and social health, during the pandemic period. Method(s): A prospective cohort study was conducted with an integrated, matched, nested case-control study. Sociode-mographic characteristics, life habits, COVID-19 history, vaccination status, compliance with mask-distance-hygiene rules, and risks (if any) for COVID-19 were inquired via online questionnaires. Physical examinations, complete blood count, biochemistry tests, and anti-SARS-CoV-2 anti-spike antibody tests were conducted for all consenting partici-pants. All analyses were established using depersonalized data. Result(s): Of the 778 participants completing the baseline visit in June-July 2021, the percentages of those vaccinated with at least one, two, and three/more doses of COVID-19 vaccine were 99.1%, 98.0%, and 11.7%, respectively;one had four doses. The median (minimum-maximum) time since the last vaccination was 134 (34-166) days for those vaccinated with two doses [CoronaVac (Sinovac Life Sciences, Beijing, China)] and 25 (14-56) days for those vaccinated with three doses [two doses of CoronaVac and a last dose of Pfizer-BioNTech mRNA vaccine (Comirnaty). The third dose was applied at a median of 164 (151-202) days after the second dose, and all were heterologous in type. The median (minimum-maximum) antibody level for the overall group was 53.55(0-5680) BAU/mL: 47.19 BAU/mL in those who received two doses, with a more than 100 times increase after a third dose (4943.64 BAU/mL). Of the 522 participants followed up to October 1, 2021, 6 PCR-positive symptomatic participants were diagnosed with COVID-19: the incidence rate was 4/1000 person-months. Conclusion(s): A 100-fold neutralizing antibody level following the third dose demonstrated the importance of a booster dose. Given the time lag between doses, antibody measurements of BioNTech recipients should be repeated in the upcoming months. Booster selection should involve antibody level, variant sensitivity of the vaccine, and individual characteristics of the recipient.Copyright © 2023, DOC Design and Informatics Co. Ltd.. All rights reserved.

Monitoring the SARS-CoV-2 Pandemic: Prevalence of Antibodies in a Large, Repetitive Cross-Sectional Study of Blood Donors in Germany-Results from the SeBluCo Study 2020-2022.

SARS-CoV-2 serosurveillance is important to adapt infection control measures and estimate the degree of underreporting. Blood donor samples can be used as a proxy for the healthy adult population. In a repeated cross-sectional study from April 2020 to April 2021, September 2021, and April/May 2022, 13 blood establishments collected 134,510 anonymised specimens from blood donors in 28 study regions across Germany. These were tested for antibodies against the SARS-CoV-2 spike protein and nucleocapsid, including neutralising capacity. Seroprevalence was adjusted for test performance and sampling and weighted for demographic differences between the sample and the general population. Seroprevalence estimates were compared to notified COVID-19 cases. The overall adjusted SARS-CoV-2 seroprevalence remained below 2% until December 2020 and increased to 18.1% in April 2021, 89.4% in September 2021, and to 100% in April/May 2022. Neutralising capacity was found in 74% of all positive specimens until April 2021 and in 98% in April/May 2022. Our serosurveillance allowed for repeated estimations of underreporting from the early stage of the pandemic onwards. Underreporting ranged between factors 5.1 and 1.1 in the first two waves of the pandemic and remained well below 2 afterwards, indicating an adequate test strategy and notification system in Germany.

Antibody response, associated symptoms and profile of patients presumably infected by SARS-CoV-2 with taste or smell disorders in the SAPRIS multicohort study.

BACKGROUND: Taste or smell disorders have been reported as strongly associated with COVID-19 diagnosis. We aimed to identify subject characteristics, symptom associations, and antibody response intensity associated with taste or smell disorders. METHODS: We used data from SAPRIS, a study based on a consortium of five prospective cohorts gathering 279,478 participants in the French general population. In the analysis, we selected participants who were presumably infected by SARS-CoV-2 during the first epidemic wave. RESULTS: The analysis included 3,439 patients with a positive ELISA-Spike. Sex (OR = 1.28 [95% CI 1.05-1.58] for women), smoking (OR = 1.54 [95% CI 1.13-2.07]), consumption of more than 2 drinks of alcohol a day (OR = 1.37 [95% CI 1.06-1.76]) were associated with a higher probability of taste or smell disorders. The relationship between age and taste or smell disorders was non-linear. Serological titers were associated with taste or smell disorders: OR = 1.31 [95% CI 1.26-1.36], OR = 1.37 [95% CI 1.33-1.42] and OR = 1.34 [95% CI 1.29-1.39] for ELISA-Spike, ELISA-Nucleocapsid and seroneutralization, respectively. Among participants with taste or smell disorders, 90% reported a wide variety of other symptoms whereas 10% reported no other symptom or only rhinorrhea. CONCLUSIONS: Among patients with a positive ELISA-Spike test, women, smokers and people drinking more than 2 drinks a day were more likely to develop taste or smell disorders. This symptom was strongly associated with an antibody response. The overwhelming majority of patients with taste or smell disorders experienced a wide variety of symptoms.

Evaluation of Interleukin-18 and Inductive Protein-10 Levels as Biological Markers Related to the Severity of Covid-19 Disease

Introduction: Interleukin-18 is produced in the early stages of viral infections and is crucial for host defense. Interferon Gamma Induced Protein 10kDa is a molecule associated with thrombosis in many studies. In this study, we aimed to investigate the levels of these two molecules, which are thought to be biomarkers in the evaluation of the severity of COVID-19 disease, in clinically different patient groups and to see their relationship with other inflammatory markers. Material(s) and Method(s): This study was conducted at Ondokuz Mayis University Faculty of Medicine Hospital between 01.04.2021 and 01.09.2021 with 60 patients with positive Severe Acute Respiratory Syndrome Coronavirus 2 polymerase chain reaction test and 30 healthy volunteers. Patients were divided into groups according to the definitions in the "Coronavirus disease 2019 diagnosis and treatment guideline" according to their clinical appearance. Interleukin-18 and Interferon Gamma Induced Protein 10kDa levels in blood samples taken from patients were studied by Enzyme-Linked ImmunoSorbent Assay method. Result(s): Interleukin-18 and Interferon Gamma Induced Protein 10kDa levels were found to be significantly higher in patients with mild to moderate pneumonia than in patients with severe pneumonia. The Interferon Gamma Induced Protein 10kDa level did not differ significantly between the mild-moderate patient group and the control group. No correlation was found between Interleukin-18 and Interferon Gamma Induced Protein 10kDa levels and C-reactive protein, D-dimer, ferritin, procalcitonin, neutrophil/lymphocyte levels. Interleukin-18 and Interferon Gamma Induced Protein 10kDa levels were not found to be associated with mortality. Conclusion(s): Interleukin-18 and Interferon Gamma Induced Protein 10kDa levels are not of vital importance in demonstrating disease severity alone. Serial measurements at specific times may better clarify its role in disease outcome. Larger studies are needed to confirm these findings.Copyright © 2023 by the authors.

Head and neck cancer management in the Covid-19 era: Our experience

Introduction: In March 2020 a new viral pandemic was declared. As etiological factor a virus belonging to the coronavirus family was isolated. This virus was named SARS-CoV-2 or COVID-19. This virus can cause different clinical frames, variating from mild symptomatology to cases of ARDS or death. Although the pandemic outbroke in China, COVID-19 had one of first hotspots in Italy, where the Public Health System needed a re-arrangement to face the disease. The incidence of oncological disease doesn't suffer any variation in relation to pandemics or emergency period, but need to be managed as soon as possible in every situation. In our maxillo-facial surgery Unit we continued our regular activities to treat all oncological patient that needed surgery during the pandemic. Because of the absence of knowledge about the COVID-19, first periods were very difficult to manage, due to the risk of infection of patients and health professionals. We decided to share our experience. Material(s) and Method(s): Between March and June 2020, 34 patients affected by head and neck cancer were admitted at our Unit. All patients underwent surgical treatment and were hospitalized until their situation guaranteed a safe discharge. Result(s): All patients treated for head and neck cancer underwent surgery. All the medical and nurse post-operative management was performed by health operators by using all the personal protective equipment (PPE) to prevent any possible infection. All contacts between patients and their family were suspended. During phase 1, all patients were submitted to a short verbal triage, measurements of physiological parameters and qualitative COVID-19 test. They were also screened by imaging to guarantee there were not any bronchopulmonary diseases referable to viral infections. During phase 2, patients were also screened by serological tests. During phase 3, all patients practiced oropharyngeal swap before being hospitalized. Discussion(s): During lockdown a re-arrangement of the management of oncological patients was mandatory. The difficulties were caused by the restriction of several activities that guarantee a normal health care system function. To date there is not a standardized therapeutic protocol to face the infection. Main therapies are symptomatic and a lot of patients need to be treated in ICUs. To prevent any possible infections, surgical activities were reserved only for urgent disease that cannot be delayed. In our Unit we continued to manage oncological patients. Social distancing and confinement measures were necessary and mandatory, in order to manage our patients. During first phases we had not any valid instrument to totally exclude COVID-19 infection. During phase 3, when oropharyngeal swaps were introduced in the screening of our patients, we could start to work in a safer way. Conclusion(s): There are still a lot of difficulties in the management of patients during COVID 19 pandemic. Because of the important consequences deriving from the delay of oncological patients their management must to be clearly defined.Copyright © 2021

Appraising SARS-CoV-2 infections after full mRNA COVID-19 vaccination in patients with systemic lupus erythematosus (SLE)

The 2019 Coronavirus disease (COVID-19) vaccine is a major weapon in the fight against the severe acute respiratory syndrome brought about by coronavirus 2 (SARS-CoV-2). The vaccine significantly reduces the risk and severity of infection by SARS-CoV-2. Patients with systemic lupus erythematosus (SLE) need protection from vaccine-preventable diseases including COVID-19. SLE patients have higher rates of severe infections due to immunosuppressive therapies and multiple immunologic defects - both of which are capable of blunting the immune responses after vaccination. In the management of COVID-19, recommendations have been developed to guide adjustments and/or continuation of immunosuppressive therapies for an effective immune response following vaccination with mRNA-based or viral vector-delivered vaccines. Monoclonal antibodies have also become available since December 2021. Here we present three cases of SLE patients who contracted COVID-19 after vaccination. One was managed in ambulatory settings and two required inpatient hospital admission.Copyright © 2022

Care of liver transplant patients during the COVID-19 pandemic: Update of the S1 guideline.

Background: The coronavirus disease 2019 (COVID-19) pandemic continues to be a challenge for the entire health care system, including the care of liver transplant recipients, who represent a vulnerable population. Objective(s): The aim of this work is to provide a practice-oriented review of the updated S1 guideline on the care of liver transplant recipients during the COVID-19 pandemic. Material(s) and Method(s): We summarize the updated guideline (as of 15 June 2022) issued by DGVS ("Deutsche Gesellschaft fur Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten") and DGAV ("Deutschen Gesellschaft fur Allgemein- und Viszeralchirurgie"). Result(s): Liver transplantation programs including evaluation, organ donation, and follow-up should continue during the pandemic, as they represent a life-saving therapeutic option. However, adjustments are possible depending on the pandemic situation. Vaccinations against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) should be carried out according to the STIKO ("Standigen Impfkomission") recommendations, and antibody testing is useful. In case of infection, various therapeutic options are available. Generally, pre-emptive adjustment of immunosuppression due to the pandemic is not recommended, but adjustment of regimens containing mycophenolate mofetil, particularly in case of SARS-CoV-2 infection, may be reasonable. Conclusion(s): Both immunization and the now available antiviral/immunomodulatory therapy improve prevention and treatment of COVID-19 in liver transplant recipients. Early detection through rigorous testing is of paramount. The improved pharmacological options also allow transplantation of positive donors or recipients under careful consideration.Copyright © 2023, The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.

Reactivation of Tuberculosis and COVID-19 in Pediatric Patients

Objective Mycobacterium tuberculosis is an immobile aerobic bacillus that causes tuberculosis (TB) disease. We aimed to evaluate the association between coronavirus disease 2019 (COVID-19), COVID-19-related drugs, TB reactivation, and TB incidence during the pandemic. Methods Eight patients who were diagnosed as having TB in Meram Medical Faculty, Necmettin Erbakan University between March 1, 2020, and December 31, 2021, at the beginning of the pandemic, were enrolled in this study. The presence of COVID-19 infection was confirmed using COVID-19 antibody tests and the patients' COVID-19 history. We evaluated the demographic data, laboratory findings, imaging tests, and pathology results of all patients. Results We checked all our patients with TB using COVID-19 antibodies (immunoglobulin [Ig]G + IgM) or polymerase chain reaction. Seven of the eight patients were female (87.5%). The median age was 16 years. Family screening of all patients was negative, and they had bacillus Calmette-Guerin vaccine scars. Two patients had chronic diseases. One was diagnosed as having primary ciliary dyskinesia in our department (patient no. 8) and the second was under follow-up by the rheumatology department with a diagnosis of juvenile idiopathic rheumatoid arthritis. Conclusion There has been an increase in the incidence of TB in children, especially in adolescents, during the pandemic period. This may be due to the pathogenic structure of the COVID-19 virus with an unknown mechanism. In addition, lifestyle changes and changes in health care policies during the pandemic may have caused this. Further research should be performed on this topic.Copyright © 2023 Authors. All rights reserved.