Predictors of active pulmonary tuberculosis among hospitalized patients with atypical symptom and sign and underlying diseases having impact on the outcome of the COVID-19 (preprint)

Background This study aimed to focus on the diagnostic use of high-resolution computed tomography (HRCT) to identify active pulmonary tuberculosis (aPTB) with atypical symptom and sign among the hospitalized patients with the underlying diseases having the impact on the outcome of the Coronavirus disease 2019 (COVID-19).Methods Within the study period (2018.01.01-2021.12.31), for patients with underlying diseases having the impact on the outcome of the COVID-19, chest –x-ray (CXR) / HRCT scans along with their patients’ charts were reviewed. These patients (n = 4,380) were classified into the [aPTB] group I (G1, n = 277) and pulmonary disease without aPTB (G2, n = 4103). Lung morphology, and lobar (segmental) distribution using CXR/HRCT, the underlying diseases and clinical symptom/sign were analyzed. To identify independent variables associated with G1, multivariate analysis was performed. Independent variables were used to generate prediction scores, which were used to develop models for predicting G1.Results For the HRCT model, multivariate analysis revealed cavitation, clusters nodules/mass (CNM) of the right/left upper lobe or ground-glass opacity were useful predictors for the G1. The negative predictive value of the HRCT model, and the CNM model for the GI were 99.3%, and 97.5%, respectively. However, the CNM model has the highest positive predictive value of 95.4%.Conclusions The CNM model may play an auxiliary role for the identification of G1 with atypical symptom and sign among the patients with underlying diseases having the impact on the outcome of the COVID-19.

The Aftermath of COVID-19: Exploring Long-Term Effects on the Organ Systems (preprint)

Background: Post-acute sequelae of SARS-CoV-2 infection (PASC) is a complicated disease that affects millions of people all over the world. Previous studies have shown that PASC impacts 10% of SARS-CoV-2 infected patients of which 50-70% are hospitalized. It has also been shown that 10-12% of those vaccinated against COVID-19 were affected with PASC and its complications. The severity and the later development of PASC symptoms is positively associated with the early intensity of the infection. Results: The generated health complications caused by PASC involve a vast variety of organ systems. Patients affected by PASC have been diagnosed with neuropsychiatric and neurological symptoms. Cardiovascular system also has been involved and several diseases such as myocarditis, pericarditis, and coronary artery diseases were reported. Chronic hematological problems such as thrombotic endothelialitis and hypercoagulability were described as a condition that could increase the risk of clotting disorders and coagulopathy in PASC patients. Chest pain, breathlessness, and cough in PASC patients were associated with respiratory system in long COVID-19 causing respiratory distress syndrome. The observed immune complications were notable, involving several diseases. Renal system also was impacted and result in raising the risk of diseases such as thrombotic issues, fibrosis, and sepsis. Endocrine gland malfunction can lead to diabetes, thyroiditis, and male infertility. Symptoms such as diarrhea, nausea, loss of appetite and taste were also among reported observations due to several gastrointestinal disorders. Skin abnormalities might be an indication of infection and long-term implications such as persistent cutaneous complaints were linked to PASC. Conclusions: Long COVID is a multidimensional syndrome with considerable public health implications, affecting several physiological systems and demanding thorough medical therapy as well as more study to address its underlying causes and long-term effects.

Correlation of SARS-CoV-2 fecal negative with gastrointestinal eubiosis in asymptomatic, mild and moderate cases of COVID-19 in Lagos, Nigeria (preprint)

Background: The severe acute respiratory syndrome, coronavirus 2 (SARS-CoV-2) when disseminated to the gastrointestinal (GI) tract through the bidirectional gut-lung crosstalk can cause alterations in GI microbiota composition and diversity. There is, however, paucity of data linking SARS-CoV-2 fecal negative with GI microbial balance. This study investigated the association of the GI bacterial composition with clinically defined asymptomatic, mild/moderate COVID-19 fecal negative individuals. A total of twelve (12) fecal samples comprising COVID-19 nasopharyngeal (NP) positive (P) (n=7) and negative (N) (n=5) consenting participants were collected and analyzed. The extracted RNA from the stool samples of NP positive were used as templates for the RT-qPCR detection of SARS-CoV-2 nucleocapsid (N) and open reading frame (ORF1ab) genes, while DNA from all samples (n=12) was used for the 16S bacterial rRNA metagenomics analysis. The Pielou index and Shannon index were used to assess the alpha diversity of the two groups (P and N) using the Kruskal-Wallis significance test, while the beta taxonomic diversity was assessed with the Bray-Curtis diversity index using the Permutational Multivariate Analysis of Variance (PERMANOVA) for the significance test. Taxonomic classification was performed using the Greengenes database trained for the hyper variable 4 of the 16S rRNA (gg_2022_10_backbone. v4. nb). Results: Participants positive for nasopharyngeal COVID-19 RT-PCR (ages 17-74 years) reported none (n=2, 28.5%), mild (n=4, 57.1%) and moderate (n=1, 14.3%) clinical symptoms. The viral genes were not detected with uniformity and richness of bacterial species in stool samples from positive and negative COVID-19 without significant differences in alpha diversity, Pielou (p=0.223), Shannon index (p = 0.062), and beta taxonomic diversity (PERMANOVA p=0.357). The taxonomic classification showed 14 phyla, 276 genera and 448 species in the samples, with Firmicutes, Bacteroidota, and Proteobacteria as the most abundant phyla. The most dominant species were beneficial microbes such as Prevotella copri, Phocaeicola vulgatus, and the immunomodulatory, anti-inflammatory bacterium Faecalibacterium prausnitzii. Conclusions: This study did not reveal any differences in the gut bacterial community of SARS-CoV-2 fecal negative, asymptomatic, mild and moderate COVID-19 compared to the apparently healthy control.

Infection episodes and islet autoantibodies in children at increased risk for type 1 diabetes before and during the COVID-19 pandemic (preprint)

Purpose. To determine the impact of the COVID-19 pandemic on the incidence rates of infection and islet autoimmunity in children at risk for type 1 diabetes. Methods. 1050 children aged 4 to 7 months with an elevated genetic risk for type 1 diabetes were recruited from Germany, Poland, Sweden, Belgium and the UK. Reported infection episodes and islet autoantibody development were monitored until age 40 months from February 2018 to February 2023. Results. The overall infection rate was 311 (95% Confidence Interval [CI], 304–318) per 100 person years. Infection rates differed by age, country, family history of type 1 diabetes, and period relative to the pandemic. Total infection rates were 321 per 100 person-years (95% CI, 304–338) in the pre-pandemic period (until February 2020), 160 (95% CI, 148–173) per 100 person-years in the first pandemic year (March 2020 - February 2021; P < 0.001) and 337 (95% CI, 315–363) per 100 person-years in subsequent years. Similar trends were observed for respiratory and gastrointestinal infections. Islet autoantibody incidence rates were 1.6 (95% CI, 1.0-2.4) per 100 person-years in the pre-pandemic period, 1.2 (95% CI, 0.8–1.9) per 100 person-years in the first pandemic year (P = 0.46), and 3.4 (95% CI, 2.3–4.8) per 100 person-years in subsequent years (P = 0.005 vs. pre-pandemic year; P < 0.001 vs. first pandemic year). Conclusions. The COVID-19 pandemic significantly altered infection patterns. Islet autoantibody incidence rates increased two-fold when infection rates returned to pre-pandemic levels.

Traditional uses and pharmacological activities of Tetracera alnifolia (Wild) Drake (preprint)

Ethnopharmacological relevance: Tetracera alnifolia (Wild) Drake, is well used in traditional Guinean medicine for the treatment of infectious skin diseases. The present aim was to contribute to the valorization of Tetracera alnifolia leaves, focused on ethnomedical, biological and phytochemical investigations. Materials and methods: we conducted an ethnomedical survey across several markets of the city of Conakry to identify 39 healers. Chloroform, methanol, dichloromethane, and aqueous extracts were tested for activities against protozoa, bacteria, fungi, HIV, and SARS-CoV-2. Results: the traditional healers indicated that T. alnifolia is used in the treatment of more than 15 pathologies including Fassa (marasmus/malnutrition), Soukhou kouye (white discharge in women), and Temou bankhi (sexual weakness in men). Leaves were the most used part. The modes of preparation included decoction and powder. Data from biological activities identicatied good activities of the methanolic extract against Leishmania infantum (MIC = 8.11 g / ml) and a moderate activity on Trypanosoma brucei (MIC = 28.15 g / ml) and Staphylococcus aureus (MIC = 29.91 g/ ml), while dichloromethane extracts acted on live SARS-CoV-2 replication with up to 53.4% inhibition at 50 g/mL. Conclusion: these results explain at least in part the traditional use of T. alnifolia

Post-Pandemic Burden of COVID-19 Related Restrictions in the Management of Digestive Tract Cancers. A Single Center Study (preprint)

The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) infection has required a complete change in the management of patients with gastrointestinal disease who needed to undergo endoscopic procedures. In the second year of the COVID-19 pandemic, due to restrictions for elective endoscopic procedures a large number of cancer patients were prevented from early diagnosis of several digestive cancers, which has led to a serious burden in the health system which nowadays needs to be dealt with. We designed a prospective study that included patients in whom access to elective endoscopic examinations during the COVID-19 pandemic has been delayed. Our aim was to investigate the impact of the COVID-19 pandemic on the diagnosis rate of digestive tract malignancies in the context of a health crisis management that generates an ethical dilemma regarding the balance of utilitarianism versus deontology. Our study shows that the decrease in the number of newly diagnosed gastrointestinal cancers by endoscopy and biopsy during the pandemic restrictions and the delay in diagnosis have hads a clear impact on stage migration due to disease progression.

Gut Microbiome Dynamics and Predictive Value in Hospitalized COVID-19 Patients: A Comparative Analysis of Shallow and Deep Shotgun Sequencing (preprint)

The COVID-19 pandemic caused by SARS-CoV-2 has led to a wide range of clinical presentations, with respiratory symptoms being common. However, emerging evidence suggests that the gastrointestinal (GI) tract is also affected, with angiotensin-converting enzyme 2, a key receptor for SARS-CoV-2, abundantly expressed in the ileum and colon. The virus has been detected in GI tissues and fecal samples, even in cases with negative respiratory results. GI symptoms have been associated with an increased risk of ICU admission and mortality. The gut microbiome, a complex ecosystem of around 40 trillion bacteria, plays a crucial role in immunological and metabolic pathways. Dysbiosis of the gut microbiota, characterized by a loss of beneficial microbes and decreased microbial diversity, has been observed in COVID-19 patients, potentially contributing to disease severity. We conducted a comprehensive gut microbiome study in 204 hospitalized COVID-19 patients using both shallow and deep shotgun sequencing methods. We aimed to track microbiota composition changes induced by hospitalization, link these alterations to clinical procedures (antibiotics administration) and outcomes (ICU referral, survival), and assess the predictive potential of the gut microbiome for COVID-19 prognosis. Shallow shotgun sequencing was evaluated as a cost-effective diagnostic alternative for clinical settings.

Trends in Nationally Notifiable Infectious Diseases in Humans and Animals During the COVID-19 Pandemic in South Korea (preprint)

Non-pharmaceutical interventions (NPIs) were implemented to cope with the coronavirus disease 2019 (COVID-19) pandemic in South Korea. These interventions could also have affected other infectious diseases, but there have been no comprehensive studies regarding their impacts. This study examined trends in notifiable infectious diseases in both humans and animals during the COVID-19 pandemic. Autoregressive integrated moving average (ARIMA) models were developed for each disease using data from 2016 to 2019, and the incidences for 2020 to 2021 were predicted. Subsequently, the predicted numbers of cases were compared with actual observations. Our findings indicated a substantial reduction in human respiratory infectious diseases during implementation of NPIs. However, human gastrointestinal infectious diseases and livestock diseases did not show a significant decrease. The results revealed that the preventive effect sizes of NPIs varied among diseases and indicated the potential for side effects, suggesting that complementary interventions are needed to minimize these negative effects.

Robust acidic pH and digestive enzyme stability of anti-SarsCov2 IgY antibodies: Implications for treatment of viral transmission thru gastrointestinal, ocular, nasal and skin tissues (preprint)

There are many paths for the transmission of SarsCov2 virus. The main routes are nasal and oral and the droplets carrying the virus can also be transmitted thru ocular and skin tissues. The gastrointestinal (small intestine), nasal, ocular and skin tissues all present an acidic pH milieu and therefore any treatment with antibodies thru these routes has to have the antibodies remain active at acid pH as well as be resistant to typical protease digestion. To this end we profiled our anti-SarasCov2 receptor binding domain IgY antibodies for retention of activity at acidic and basic pHs and trypsin digestion. We find that the IgY are strongly resistant to denaturation at acid pH as well as not digested by trypsin. Our data strongly support the use of these IgY in treatment of viral transmission thru the GI, nasal, ocular and skin all tissues where the pH is acidic. We also provide an enabling platform to rapidly asses the suitability of any antibody or protein therapeutic for use at acidic pH.

Incidence and Severity of COVID-19 with the use of the MMR Vaccine before or after the COVID-19 Vaccine (preprint)

IntroductionThe MMR vaccine has been shown by several studies over the years to have a potent effect on heterologous immunity. The reduction in mortality and respiratory and gastrointestinal diseases in childhood has been consolidated with recent studies demonstrating a better evolution of COVID-19 with the use of this vaccine. Stimulation of innate immunity by the MMR vaccine can be very useful, both used alone or in association with other vaccines, especially those for COVID-19. ObjectivesTo evaluate the decrease in the incidence of infection or severity of COVID-19 with the use of the MMR vaccine before and after the use of specific vaccines against COVID-19. MethodsThis extension analysis followed 120 volunteer healthcare professionals aged 18 to 60 who received the MMR vaccine before the specific COVID-19 vaccine and 73 volunteers who used the MMR vaccine after the COVID-19 vaccine. Visits to the Research Center were carried out at an average interval of 4 weeks for 12 weeks. The diagnosis of COVID-19 was performed using the RT-PCR technique for the SARS-CoV-2 virus. ResultsThe most used vaccine against COVID-19 was Coronavac in 59.1%. A total of 44 cases of COVID-19 were diagnosed (20% of the sample), the vast majority of which were mild cases (70.5%). There was no difference in the incidence and severity of COVID-19 in health professionals who used the MMR vaccine before or after the specific vaccine against the SARS-CoV-2 virus (Coronavirus or AstraZeneca). ConclusionThe incidence and severity of COVID-19 does not differ with the use of the MMR vaccine before or after the specific vaccine against COVID-19.

Text mining biomedical literature to identify extremely unbalanced data for digital epidemiology and systematic reviews: dataset and methods for a SARS-CoV-2 genomic epidemiology study (preprint)

There are many studies that require researchers to extract specific information from the published literature, such as details about sequence records or about a randomized control trial. While manual extraction is cost efficient for small studies, larger studies such as systematic reviews are much more costly and time-consuming. To avoid exhaustive manual searches and extraction, and their related cost and effort, natural language processing (NLP) methods can be tailored for the more subtle extraction and decision tasks that typically only humans have performed. The need for such studies that use the published literature as a data source became even more evident as the COVID-19 pandemic raged through the world and millions of sequenced samples were deposited in public repositories such as GI-SAID and GenBank, promising large genomic epidemiology studies, but more often than not lacked many important details that prevented large-scale studies. Thus, granular geographic location or the most basic patient-relevant data such as demographic information, or clinical outcomes were not noted in the sequence record. However, some of these data was indeed published, but in the text, tables, or supplementary material of a corresponding published article. We present here methods to identify relevant journal articles that report having produced and made available in GenBank or GISAID, new SARS-CoV-2 sequences, as those that initially produced and made available the sequences are the most likely articles to include the high-level details about the patients from whom the sequences were obtained. Human annotators validated the approach, creating a gold standard set for training and validation of a machine learning classifier. Identifying these articles is a crucial step to enable future automated informatics pipelines that will apply Machine Learning and Natural Language Processing to identify patient characteristics such as co-morbidities, outcomes, age, gender, and race, enriching SARS-CoV-2 sequence databases with actionable information for defining large genomic epidemiology studies. Thus, enriched patient metadata can enable secondary data analysis, at scale, to uncover associations between the viral genome (including variants of concern and their sublineages), transmission risk, and health outcomes. However, for such enrichment to happen, the right papers need to be found and very detailed data needs to be extracted from them. Further, finding the very specific articles needed for inclusion is a task that also facilitates scoping and systematic reviews, greatly reducing the time needed for full-text analysis and extraction.

Gastrointestinal manifestations of long-term effects after COVID-19 infection in patients with dialysis or kidney transplantation: An observational cohort study.

BACKGROUND: Prolonged symptoms after corona virus disease 2019 (Long-COVID) in dialysis-dependent patients and kidney transplant (KT) recipients are important as a possible risk factor for organ dysfunctions, especially gastrointestinal (GI) problems, during immunosuppressive therapy. AIM: To identify the characteristics of GI manifestations of Long-COVID in patients with dialysis-dependent or KT status. METHODS: This observational, prospective study included patients with COVID-19 infection, confirmed by reverse transcription polymerase chain reaction, with the onset of symptoms between 1 January 2022 and 31 July 2022 which was explored at 3 mo after the onset, either through the out-patient follow-up or by telephone interviews. RESULTS: The 645 eligible participants consisted of 588 cases with hemodialysis (HD), 38 patients with peritoneal dialysis (PD), and 19 KT recipients who were hospitalized with COVID-19 infection during the observation. Of these, 577 (89.5%) cases agreed to the interviews, while 64 (10.9%) patients with HD and 4 (10.5%) cases of PD were excluded. The mean age was 52 ± 11 years with 52% women. The median dialysis duration was 7 ± 3 and 5 ± 1 years for HD and PD groups, respectively, and the median time post-transplantation was 6 ± 2 years. Long-COVID was identified in 293/524 (56%) and 21/34 (62%) in HD and PD, respectively, and 7/19 (37%) KT recipients. Fatigue was the most prevalent (96%) of the non-GI tract symptoms, whereas anorexia (90.9%), loss of taste (64.4%), and abdominal pain (62.5%) were the first three common GI manifestations of Long-COVID. Notably, there were 6 cases of mesenteric panniculitis from 19 patients with GI symptoms in the KT group. CONCLUSION: Different from patients with non-chronic kidney disease, there was a high prevalence of GI manifestations of Long-COVID in dialysis-dependent patients and KT recipients. An appropriate long-term follow-up in these vulnerable populations after COVID-19 infection is possibly necessary.

SARS-CoV-2 variants of concern exhibit differential gastro-intestinal tropism and pathogenesis in the Syrian golden hamster model. (preprint)

The Coronavirus Disease 2019 (COVID-19) pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has taken its toll on worldwide public health infrastructure. SARS-CoV-2 is reported to exhibit wide tissue tropism, contributing to its severe pathogenicity that often culminates in multiple-organ failure. The onslaught of this disease has intensified due to the emergence of variants of concern (VOC), such as Delta and Omicron. These variants have been linked to gastrointestinal (GI) symptoms, suggesting a potential fecal-oral route of viral transmission. Here we compared the broad tissue tropism of ancestral Hong-Kong SARS-CoV-2 (SARS-CoV-2 HK) against Delta and Omicron VOCs in aa hamster model by analyzing tissue samples collected from the upper and lower respiratory system and the GI tract. We observed an overall increase in vRNA load and pro-inflammatory cytokines, especially in GI tracts of animals infected with Delta virus, indicating selective virus tropism and pathology in these tissues. However, no apparent spike in Delta viral load was observed in the large intestine and fecal matter. Overall, our research investigates the wide range of tissues that various SARS-CoV-2 strains can infect in hamsters and presents evidence supporting the increased preference of Delta VOCs for infecting the GI tract.

Large scale phenotyping of long COVID inflammation reveals mechanistic subtypes of disease (preprint)

One in ten SARS-CoV-2 infections result in prolonged symptoms termed "long COVID", yet disease phenotypes and mechanisms are poorly understood. We studied the blood proteome of 719 adults, grouped by long COVID symptoms. Elevated markers of monocytic inflammation and complement activation were associated with increased likelihood of all symptoms. Elevated IL1R2, MATN2 and COLEC12 associated with cardiorespiratory symptoms, fatigue, and anxiety/depression, while elevated MATN2 and DPP10 associated with gastrointestinal (GI) symptoms, and elevated C1QA was associated with cognitive impairment (the proteome of those with cognitive impairment and GI symptoms being most distinct). Markers of neuroinflammation distinguished cognitive impairment whilst elevated SCG3, indicative of brain-gut axis disturbance, distinguished those with GI symptoms. Women had a higher incidence of long COVID and higher inflammatory markers. Symptoms did not associate with respiratory inflammation or persistent virus in sputum. Thus, persistent inflammation is evident in long COVID, distinct profiles being associated with specific symptoms.

Implementing Germ Defence digital behaviour change intervention via all primary care practices in England to reduce respiratory infections during the COVID-19 pandemic: an efficient cluster randomised controlled trial using the OpenSAFELY platform. (preprint)

Background:  Germ Defence (www.germdefence.org) is an evidence-based interactive website that promotes behaviour change for infection control within households. To maximise the potential of Germ Defence to effectively reduce the spread of COVID-19 the intervention needed to be implemented at scale rapidly. Methods: With the approval of NHS England, we implemented an efficient two-arm (1:1 ratio) cluster randomised controlled trial (RCT) to examine the effectiveness of randomising implementation of Germ Defence via GP practices across England, UK, compared with usual care. GP practices randomised to the intervention arm (n=3292) were emailed and asked to disseminate the Germ Defence intervention to all adult patients via mobile phone text, email or social media. GP practices randomised to the usual care arm (n=3287) maintained standard management for the 4-month trial period after and then asked to share Germ Defence with their adult patients.  The primary outcome was the rate of GP presentations for respiratory tract infections (RTI) per patient. Secondary outcomes comprised rates of acute RTIs, confirmed COVID-19 diagnoses, suspected COVID-19 diagnoses, COVID-19 symptoms, gastrointestinal infection diagnoses, antibiotic usage, hospital admissions.  The impact of the intervention on outcome rates was assessed using negative binomial regression modelling within the OpenSAFELY platform. The uptake of intervention by GP practice, and by patients were measured via website analytics. Results: Germ Defence was used 310,731 times. The average satisfaction score after using the website was 7.52 (0-10 not at all to very satisfied, N = 9933). There was no evidence of a difference in the rate of RTIs between intervention and control practices (rate ratio (RR) 1.01, 95%CI 0.96, 1.06, p=0.70). This was similar to all other eight health outcomes. Patient engagement within intervention arm practices ranged from 0- 48% of a practice list. Practices with high levels of intervention uptake (>11%) had a lower proportion of minority ethnic groups. Conclusions:  We demonstrated that rapid large-scale implementation of a digital behavioural intervention can be evaluated with a novel efficient prospective RCT methodology analysing routinely collected patient data entirely within a trusted research environment. Trial registration: This trial was registered in the ISRCTN registry (14602359) on 12 August 2020.

Gastrointestinal Symptoms of Monkeypox Infection: A systematic review and meta-analysis.

Since early May 2022, outbreaks of Monkeypox (Mpox) cases have emerged and become a global concern. Studies exploring the gastrointestinal symptoms and/or liver injury of Mpox are still very limited. This systematic review and meta-analysis is the first to summarize the gastrointestinal symptoms reported by Mpox patients. We searched for Mpox studies published until October 21, 2022, in MEDLINE, EMBASE, SCOPUS, and organization websites. Mpox studies were observational studies that reported at least one of either gastrointestinal symptoms and/or liver injury in Mpox patients. Meta-analysis was done to obtain the pooled prevalence of gastrointestinal symptoms in Mpox patients. Subgroup analyses were done based on the study location, age groups, and Mpox Clades. The quality of included studies was assessed using the NIH Quality Assessment Tool. Overall, 31 studies that reported gastrointestinal symptoms and/or liver injury in Mpox patients were included. The reported gastrointestinal symptoms were abdominal pain, anorexia, diarrhea, nausea, and vomiting. There is a lack of reporting for liver injury. The most prevalent gastrointestinal symptoms in Mpox patients were anorexia (47%; 95% confidence interval [CI] 41%-53%), followed by vomiting (12%; 95% CI 11%-13%), nausea (10%; 95% CI 9%-11%), abdominal pain (9%; 95% CI 8%-10%), and diarrhea (5%; 95% CI 4%-6%). Additionally, the prevalence of proctitis, rectal/anal pain, and rectal bleeding were 11% (95% CI 11%-12%), 25% (95% CI 24%-27%), and 12% (95% CI 11%-13%), respectively. Anorexia was the most frequently reported gastrointestinal symptom in Mpox patients, followed by vomiting, nausea, abdominal pain, and diarrhea. Proctitis is a novel presentation of Mpox in the 2022 outbreak.

Electroacupuncture in Regulating Gastrointestinal Symptoms of COVID-19: A Mini-review.

Nearly three years into the COVID-19 pandemic, there is still no effective treatment. In the meantime, more and more evidence indicate that gastrointestinal symptoms are important manifestations of COVID-19. Therefore, the involvement of multiple system symptoms brings a lot of burden and harm to patients. To our knowledge, traditional Chinese medicine (TCM) has a remarkable effect on improving gastrointestinal function. In particular, a considerable number of clinical practices during the pandemic have demonstrated the significant value of electroacupuncture (EA) in regulating the gastrointestinal function of COVID-19. In summary, EA can regulate the gastrointestinal function of COVID-19. As more is learned about EA, its potential value in COVID-19 deserves further consideration. In this review, we will elucidate the potential efficacy and mechanism of EA in the treatment of gastrointestinal symptoms of COVID-19.

Gut distress and intervention via communications of SARS-CoV-2 with mucosal exposome.

Acute coronavirus disease 2019 (COVID-19) has been associated with prevalent gastrointestinal distress, characterized by fecal shedding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA or persistent antigen presence in the gut. Using a meta-analysis, the present review addressed gastrointestinal symptoms, such as nausea, vomiting, abdominal pain, and diarrhea. Despite limited data on the gut-lung axis, viral transmission to the gut and its influence on gut mucosa and microbial community were found to be associated by means of various biochemical mechanisms. Notably, the prolonged presence of viral antigens and disrupted mucosal immunity may increase gut microbial and inflammatory risks, leading to acute pathological outcomes or post-acute COVID-19 symptoms. Patients with COVID-19 exhibit lower bacterial diversity and a higher relative abundance of opportunistic pathogens in their gut microbiota than healthy controls. Considering the dysbiotic changes during infection, remodeling or supplementation with beneficial microbial communities may counteract adverse outcomes in the gut and other organs in patients with COVID-19. Moreover, nutritional status, such as vitamin D deficiency, has been associated with disease severity in patients with COVID-19 via the regulation of the gut microbial community and host immunity. The nutritional and microbiological interventions improve the gut exposome including the host immunity, gut microbiota, and nutritional status, contributing to defense against acute or post-acute COVID-19 in the gut-lung axis.

A real-world pharmacovigilance study of FDA Adverse Event Reporting System (FAERS) events forpaxlovid and molnupiravir (preprint)

Questions have been raised about the safety of paxlovid and molnupiravir as antiviral drugs for the treatment of COVID-19 since the pandemic. We applied t he FDA Adverse Event Reporting System (FAERS) to assess the safety by performing a disproportionality analysis to identify potential risks of paxlovid and molnupiravir. The number of paxlovid signals was approximately 11 times higher than that of molnupiravir, with most signals of these two drugs overlapped. General disorders and administration site conditions (ROR: 0.52, 95% CI: 0.58- 2.18), infections and infestations (ROR: 0.18, 95% CI: 0.23-6.64), nervous system disorders (ROR: 1.41, 95% CI: 0.79-1.58) were the top 3 signals for paxlovid, with gastrointestinal disorders (ROR: 4.13, 95% CI: 0.27-4.54), skin and subcutaneous tissue disorders (ROR: 11.51, 95% CI: 0.10-12.92), nervous system disorders (ROR: 1.41, 95% CI: 0.79-1.58) for molnupiravir. Paxlovid-induced infections, skin and subcutaneous tissue disorders, and molnupiravir-induced musculoskeletal and connective tissue disorders, as well as potential safety signals on the heart, eyes and ears needlong-term observation, especially for signals not included in the instructions. The adverse events on this study confirms most of the instructional information for paxlovid and molnupiravir, both drugs need to be monitored for risk signals such as acute respiratory failure, hematologic and lymphatic system.