Background/aim: The relationship between COVID-19 fatality and quality health care in OECD countries was aimed to be examined, considering the effectiveness of primary health care, the effectiveness of secondary health care. Materials and methods: Data from OECD countries were collected from open-access websites. Dependent variable is COVID-19 fatality, independent variables are effectiveness of primary health care, the effectiveness of secondary health care, gross domestic product, median age, number of hospital beds, number of intensive care unit beds, number of doctors and nurses, number of computed tomography scanners, educational status and air pollution. Spearman Rho correlation and partial correlation were used in the analysis of the data, and generalized linear regression analysis was performed. Results: A statistically significant relationship was found between case fatality rates and the effectiveness of secondary health care (p<0,05). The relationships between case fatality rates and other health, demographic indicators are not statistically significant. In Generalized Linear Model (GLM-Logit Model) analysis results, only the effectiveness of secondary health care (p< 0,01) and the number of hospital beds (p<0,05) were found to be statistically significant. Conclusion: Satisfaction with quality health care is not associated with COVID-19 fatality. As the effectiveness of secondary health care increases, the fatality of COVID-19 decreases. The effectiveness of primary health care has no effect on COVID-19 fatality.

Background: The transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is complex and multifactorial. We aimed to identify the risk factors for infection among the household contacts of index patients and to determine the incubation period, serial interval, and estimates of secondary infection rate. Methods: We conducted a study in three districts of Kerala among the inhabitants of households of reverse transcriptase polymerase chain reaction (RT-PCR)-positive coronavirus disease (COVID-19) patients between January and July 2021. COVID-19-positive patients and corresponding contacts were enrolled and followed up for 28 days to determine RT-PCR positivity and the presence of total antibodies against SARS-CoV-2 on days 1, 7, 14, and 28 from the date of enrolment. Results: The mean incubation period, serial interval, and generation time were 1.6, 3, and 3.9 days, respectively. The secondary infection rate was 43.0%. Individuals who worked outside the home were protected, whereas those who had kissed the COVID-19-positive patients during illness were more than twice at risk of infection than those who had not kissed the COVID-19-positive patients. Similarly, the contacts who had shared a toilet with the COVID-19-positive patients were more at risk than those who had not shared a toilet. However, the contacts who reported using masks were at a higher risk of infection in household settings. Conclusions Assessment of SARS-CoV-2 transmission in household settings is important, considering its high secondary infection rate. Close physical contact and toilet sharing increase the risk of infection. This study demonstrates shorter incubation period and serial interval.

Covid-19 causedhospitalizations, severe disease and deaths in any age, including in the youngest children. The aim of this multicenter national study is to characterize the clinical and the prognostic role of lung ultrasound (LUS) in children with Covid-19. We enrolled children between 1 month and 18 years of age diagnosed with SARS-CoV2 infection and whounderwenta lung ultrasound within 6 hours from firstmedical evaluation. A total of 213 children were enrolled, 51.6%were male, median age was2 years and 5 months (IQR 4mm- 11 yearsand4 months).One hundred and fortyeight (69.4%) children were admitted in hospital, 9 (6.1%) in pediatric intensive care unit.We found an inverse correlation between the LUS score and the oxygen saturationatthe clinical evaluation (r = −0.16; p = 0.019). Moreover, LUS scores were significantly higher in patients requiring oxygen supplementation (8 (IQR 3 - 19) vs 2 (IQR 0 - 4); p= 0.001). Among LUS pathological findings, irregular pleural line, sub-pleural consolidations and pleural effusions were significantly more frequentin patients whoneeded oxygen supplementation (p = 0.007; p = 0.006 andp = 0.001, respectively). This multicentric study confirmed that LUS is able to detect Covid-19 low respiratory tract involvement, which is characterized by pleural line irregularities, vertical artifacts and subpleural consolidations. Notably, children with higher LUS score have an higher risk of hospitalization or need for oxygen supplementation, supporting LUS as a valid and safe point-of-care first level tool for the clinical evaluation of children with Covid-19.

Background: Data on the outcome and risk factors of pediatric patients with SARS-CoV-2 infection (COVID-19) following hematopoietic stem cell transplantation (HSCT) are limited. Objectives: We aimed to describe risk factors for a severe course and mortality. Method: In this nationwide study, data were collected retrospectively from 28 transplant centers. Results: One hundred ninety-six children [(63.8% male; median age 8.75 (IQR, 4.86-14.30)] who received allogeneic (n: 184, 93.9%) or autologous (n: 12, 6.1%) HSCT were included. The median time from HSCT to SARS-CoV-2 infection was 207.5 days (IQR, 110.2-207.5). The most common clinical manifestation was fever (58.2%), followed by cough (33.7%); 43 cases (21.9%) were asymptomatic. Lower respiratory tract disease (LRTD) and multisystem inflammatory syndrome in children (MIS-C) developed in 58 (29.6%) and 8 (4.1%) patients, respectively. Twenty-six patients (13.3%) required ICU admission. Nine patients died at a median of 17 days (min-max 1-33) after COVID-19 diagnosis, 6 of whom died due to the disease, with a COVID-19 lethality rate of 3.1%. The 6-week overall survival was 95.4% (95% CI 92.5-98.3). Multivariate analysis found that HSCT with a mismatched donor (OR, 8.98, p: 0.039) and LRTD (OR, 61.55, p: 0.001) were independent risk factors for ICU admission; MIS-C (OR, 9.55, p: 0.044) and lymphopenia (OR, 4.01, p: 0.030) at diagnosis were risk factors for mortality. Conclusion: Overall mortality was lower in children than in adult counterparts, and HSCT with a mismatched donor, lymphopenia, LRTD, MIS-C and ICU admission were important risk factors for adverse outcomes.

Although, the COVID-19 pandemic is profoundly changing, data on the effect of vaccination and duration of protection can still be advantageous, especially for patients with COPD, who are more vulnerable to respiratory infections. The Hungarian-COVID-19 registry was retrospectively investigated for vaccine effectiveness (VE) and daily risk for infection and hospitalization by time since the last vaccination and vaccine type in adults with COPD diagnosis and an exact-matched control group during the Delta VOC wave in Hungary. For the matching sex, age, major comorbidities, vaccination status, and prior infection was used on August 23, 2021. The study population included 373 962 cases divided into COPD patients (age: 66.67±12.66) and a 1:1 matched group (age: 66.73±12.67). In both groups, the female/male ratio was 52.2:47.7. There was no significant difference between the groups in daily risks for infection or hospitalization among the unvaccinated. Regarding vaccinated cases, a faster decline of effectiveness was noted for hospitalization prevention in the COPD group regardless of vaccine type. The VE reduction in this group was from 90.1% (mRNA) and 87.8% (other) to 48.8% and 34.1% respectively in 180 days. Based on the time-stratified multivariate Cox analysis of the vaccinated cases, the hazard ratio was 1.09 (95% CI: 1.05-1.14) for infection and 1.87 (95% CI: 1.59-2.19) for hospitalization in the COPD group. Based on our study COPD patients are at higher risk for SARS-Cov2 VE waning and have altogether a higher risk for infection and need for hospitalization emphasizing suggestion for revaccination measures in this patient population.

The song alluded in the title could be continued by saying that people around the countries criticised the measures to contain COVID-19. Beliefs in a just word (BJW) are related with affective reactions triggered by extreme events. The aim was to test Affective Events Theory (AET) by analysing to what extent work environments have influence on affective experience and job outcomes. Participated 449 teleworkers in Brazil and 236 in France, countries with similar periods of compulsory telework, but that adopted different policies. Results revel low positive emotions tend to decrease perceived job satisfaction when BJW is high in both contexts. Among French teleworkers, it is also true when we have high negative emotions. BJW directly affects job performance and satisfaction in Brazil, but it is only valid for job satisfaction in France. Results offers support for AET and presents how work environments indirectly influence affective experience and job outcomes.

SARS-CoV-2 and its ever-emerging variants, are spread from host-to-host via expelled respiratory aerosols and saliva droplets. Knowing the number of virions which are exhaled by a person requires precise measurements of the size, count, velocity and trajectory of the virus-laden particles that are ejected directly from the mouth. These measurements are achieved in 3D, at 15000 images/second, and are applied when speaking, yelling, and coughing. In this study 33 events have been analysed by post-processing ~500000 images. Using these data, the flow rate of SARS-CoV-2 virions have been evaluated. At high concentrations, 10^7 virions/mL, it is found that 136 to 231 virions are ejected during a single cough, where the virion flow rate peak is capable of reaching 32 virions within a millisecond. This peak can reach tens of virions/ms when yelling, but reduced to only a few virions/ms when speaking. At medium concentrations, ~10^5 virions/mL, those results are hundreds of times lower. The total number of virions that are ejected when yelling at 110db, instead of speaking at 85db, increases by two to three fold. From the measured data analysed in this article, the flow rate of other diseases such as influenza, tuberculosis or measles, can also be estimated. As these data are openly accessible, they can be used by modellers for the simulation of saliva droplet transport and evaporation, allowing to further advance our understanding of airborne pathogen transmission.

Mitochondria play a central role in the innate and acquired response against viral infections. Common mtDNA variants have been associated with severe COVID-19 and mtDNA depletion. A poly C length variation has been associated with mtDNA instability and increased risk for several diseases. We studied 482 patients who required treatment in the intensive care unit and age matched population controls. The 16184-16193 poly-C and 514-523 CA-repeats were determined by fluorescent capillary electrophoresis and Sanger sequencing of PCR fragments. We found a significantly higher frequency of 16184-16193 mtDNA poly-C heteroplasmy in patients aged ≤60 compared to patients aged >60 years. Poly-C heteroplasmy did not differ between the age control groups. Poly-C heteroplasmy was associated with the presence of the 16223 T allele, that was associated with the risk of critical COVID-19 at ≤60 years. In Conclusion, heteroplasmy in the poly-C tract of the mtDNA control region might be a marker for critical COVID-19. The 16184-16193 heteroplasmy was linked to the 16223 T allele, that was significantly increased among patients aged ≤60 years. This finding requires validation in other cohorts and to determine the functional link between length variation in the mitochondrial DNA control sequence and risk of severe SARS-CoV-2 disease.

Cross-reactive cellular and humoral immunity can substantially contribute to antiviral defense against SARS-CoV-2 variants of concern (VOC). While the adult SARS-CoV-2 cellular and humoral immunity and its cross-recognition potential against VOC is broadly analyzed, similar data regarding the pediatric population are missing. In this study, we perform an analysis of the humoral and cellular SARS-CoV-2 response immune of 32 convalescent COVID-19 children (children), 27 convalescent vaccinated adults(C+V+) and 7 unvaccinated convalescent adults (C+V-). SARS-CoV-2 reactive T cell response is analyzed via multiparametric flowcytometry and humoral immunity is addressed via pseudovirus neutralization assay. Similarly to adults, a significant loss of neutralizing capacity against delta and omicron VOC was observed 6 months after SARS-CoV-2 infection. While SAR-CoV-2 neutralizing capacity was comparable among children and C+V- against all VOC, children demonstrated as expected an inferior humoral response when compared to C+V+. Nevertheless, children generated SARS-CoV-2 reactive T cells with broad cross-recognition potential. When compared to V+C+, children presented even comparable frequencies of WT-reactive CD4+ and CD8+ T cells with high avidity. Our results suggest that following SARS-CoV-2 infection children generate a humoral SARS-CoV-2 response with neutralizing potential comparable to unvaccinated COVID-19 convalescent adults as well a sustained SARS-CoV-2 cellular response cross-reactive to VOC.

A document by Qingyan Tong. Click on the document to view its contents.

Abstract Rationale: Recent studies suggest that both hypo- and hyper-inflammatory ARDS phenotypes characterize severe COVID-19-related pneumonia. The role of lung SARS-CoV-2 viral load in contributing to these phenotypes remains unknown. Objectives: To redefine COVID-19 ARDS phenotypes when considering semi-quantitative SARS-CoV-2 RT-PCR in the bronchoalveolar lavage of intubated patients. To compare the relevance of deep respiratory samples vs plasma in linking the immune response and the semi-quantitative viral loads. Methods: Eligible subjects were adults diagnosed with COVID-19 ARDS who required mechanical ventilation and underwent bronchoscopy. We recorded the immune response in the bronchoalveolar lavage and plasma and semi-quantitative SARS-CoV-2 RT-PCR in the bronchoalveolar lavage. Hierarchical clustering on principal components was applied separately on the two compartments datasets. Baseline characteristics were compared between clusters. Measurements and Results: 20 subjects were enrolled between August 2020 and March 2021. Subjects underwent bronchoscopy on average 3.6 days after intubation. All subjects were treated with dexamethasone prior to bronchoscopy, 11 of 20 (55.6%) received remdesivir and 1 of 20 (5%) received tocilizumab. Adding viral load information to the classic two cluster model of ARDS revealed a new cluster characterized by hypo-inflammatory responses and high viral load in 23.1% of the cohort. Hyperinflammatory ARDS was noted in 15.4% of subjects. Bronchoalveolar lavage clusters were more stable compared to plasma. Conclusions: We identified a unique group of critically ill subjects with COVID-19 ARDS who exhibit hypo-inflammatory responses but high viral loads in the lower airways. Our approach adds the infection dimension to ARDS phenotypes described in COVID-19 pneumonia

BACKGROUND: Management of Covid 19 has been a challenge to health care system. Covid-19 pandemic led to prescribing a greater number of drugs for curing the disease as in initial phase of pandemic due to lack of understanding of pathophysiology of Covid 19, symptomatic treatment was given as no definite treatment was available. This presented an opportunity to assess prescribing practices during the pandemic. AIM: Prescription audit and effect of co-morbidities on indoor Covid-19 patients. METHODS: The present study is a retrospective cohort to assess 300 random prescriptions from indoor Covid 19 patients of a tertiary care teaching hospital. The parameters analysed in the process of prescription audit were, patients’ demographics data, prescribing standards according to WHO core indicators, clinical diagnosis with co-morbid condition, legibility of hand writing, doctors name and signature, outcome of disease. RESULTS: A total of 300 prescriptions were analyzed, among them 198(66%) were male and 102(34%) females. Total 2972 drugs were prescribed. The average number of drugs per prescription are 9.90, percentage of drugs prescribed by generic name is 88%, percentage of encounters with antimicrobials is 99.66%, percentage of encounters with injections is 44%, percentage of drugs prescribed from National Essential Drug List is 83.34%. 167 patients (55.67%) presented with co-morbidity. The average duration of hospital stay is approximately 8 days. This study reveals impact of co-morbidities on Covid 19. CONCLUSION: Each and every patient received antimicrobial in the form of antibiotic or antiviral. The effect of co-morbidity has a significant influence on the outcome of patients having covid 19, as in this study mortality rate in diabetic patients is higher than non-diabetics. Similarly, in hypertension, mortality rate is higher than in non-hypertensive patients.

Background: Post COVID-19 syndrome has emerged as a long-term complication in adults and children, its effect on adolescents’ performance in school is not well studied. Methods: This is a survey of children in grades 10-12 looking into the physical/psychological impact of prolonged post COVID-19 symptoms on school performance. Results: 32/54 students with a mean age of 16 years old had COVID-19. Two were hospitalized, 10 had symptoms lasting more than 4 weeks. Commonly reported chronic symptoms were fatigue and cough. Seven students quit sports, 8 had decrease in their academic performance. Adolescents with a family history of long haulers and those being infected more than once where more likely to develop prolonged symptoms, quit sports and perform poorly in school. 3/14 (21%) reported not seeking help. Conclusion: Post COVID-19 syndrome is associated with decline in physical and mental performance in school yet only 79% of adolescents will talk about it.

The identification of deleterious mutations in different variants of SARS-CoV-2, and their roles in the morbidity of COVID-19 patients are yet to be explored. Analyzing 5,724 complete genomes of SARS-CoV-2, sequenced from deceased COVID-19 patients globally during January 2020 to February 2023, we found that SARS-CoV-2 genomes of the deceased belonged to 21 Nextstrain clades, of which clade 20I (Alpha variant) was the most predominating clade followed by clade 20H (Beta variant) and clade 20J (Gamma variant). The highest percentage (33.4%) of SARS-CoV-2 genomes from deceased patients were sequenced from North America, while the lowest (0.98%) was from Africa. The “G” clade was found to be predominated in the SARS-CoV-2 genomes Asian, African, and North American regions whereas “GRY” clade outweighed in Europe. We identified 35,799 nucleotide mutations throughout the genome keeping the highest (n = 11,402) frequency in the spike protein. More importantly, 4,150 point-specific amino acids (aa) mutations in SARS-CoV-2 genomes, and of them, D614G (20%) and N501Y (14%) deleterious mutations in the spike protein were found as the top two mutations worldwide. We also detected five frequent deleterious aa mutations such as G18V, W45S, I33T, P30L, and Q418H, responsible for defining each clade of the SARS-CoV-2. Our novel findings could therefore be useful for genomic surveillance and monitoring the integrated pattern of SARS-CoV-2 infection, its emerging variants, and their impacts on developing effective vaccination and control methodology.

Introduction Viral infections are associated with pulmonary exacerbations in children with Cystic Fibrosis (cwCF), but after 3 years of SARS-CoV-2 pandemic, whether cwCF are at higher risk of developing COVID-19 or its adverse consequences remains controversial. Methods We conducted an observational, multicenter, cross-sectional study of cwCF infected by SARS-CoV-2 between March 2020 and June 2022, (1 st to 6 th COVID-19 pandemic waves) in Spain. The study aimed to describe patients’ basal characteristics, SARS-CoV-2 clinical manifestations and outcomes, and whether there were differences across the pandemic waves. Results During study time, 351 SARS-CoV2 infections were reported among 341 cwCF. Median age was 8.5 years (range 0-17) and 51% were female. Cases were unevenly distributed across the pandemic, with most cases (82%) clustered between November 2021 and June 2022 (6 th wave, also known as Omicron Wave due to the higher prevalence of this strain in that period in Spain). Most cwCF were asymptomatic (24.8%) or presented with mild Covid-19 symptoms (72.9%). Among symptomatic, most prevalent symptoms were fever (62%) and increased cough (53%). No multisystem inflammatory syndrome (MIS-C), persisting symptoms, long-term sequelae or deaths were reported. Conclusions Spanish current data indicate that cwCF do not experience higher risks of SARS-CoV-2 infection nor worse health outcomes or sequelae. Changes in patients’ basal characteristics, clinical courses and outcomes were detected across waves. While the pandemic continues, and new SARS-CoV-2 variants are being identified, a worldwide monitoring of COVID-19 in pediatric CF patients is needed.

Objective: To evaluate the frequency and burden of disease of SARS-CoV-2 and other respiratory viruses in children under the age of 2 months. Methods: A retrospective, cross-sectional, single-center study was conducted between March 2021, and February 2022. All children under the age of 2 months and tested for SARS-CoV-2 were included. The frequency of SARS-CoV-2, of other respiratory viruses and the burden of disease caused by SARS-CoV-2 and other respiratory viruses were evaluated. Results: 727 children with an RT-PCR test for SARS-CoV-2 were included (mean age: 0.9 months (±0.6); boys: 57%); 514 (71%) in the emergency room and 213 (29%) in hospital. Among them, 62 (8.5%) had a positive RT-PCR test for SARS-CoV-2, more often in the Omicron period (23%) than in the Alpha period (4%). Of the 565 (78%) with a multiplex RT-PCR test for other viruses, 325 (58%) were positive. Children with a positive SARS-CoV-2 were less likely to have required respiratory support (p=.001), enteral nutrition (p=.03), or intensive care admission (p=.01) and had a shorter hospital stay than children with other respiratory viruses (5d vs. 7d, p=.007). Conclusion: In this young population of children, SARS-CoV-2 infection was less frequent and less severe than other viral respiratory infections.

The progenitor of SARS-CoV-2 remains unknown, according to a preliminary report released on 9 June 2022 by the WHO panel. Jesse Bloom pondered about the SARS-CoV-2 emergence long before December 2019, putting in check the joint WHO-China report. In addition, a rare conflict of interest occurred: ‘Mr. Inattention’ was a member of the team that the WHO sent to China in 2021 to investigate the COVID-19 origin. The presence of ‘Mr. Inattention’ provides evidence that WHO overlooked a troubling possibility: apparently, there were those who had at least planned to develop full-length infectious clones of bat SARS-related coronaviruses, with insertion of a fragment (proteolytic cleavage site) of this virus into bat coronaviruses, such a cleavage site being able to interact with furin, an enzyme expressed in human cells. Some moral threshold may have been damaged, threatening civilizational security and public health, given the hypothesis of an unnatural origin of SARS-CoV-2. In other words, there is a possibility of a lab-associated origin of this novel pathogen. This makes it illegal to patent vaccines against COVID-19 in Brazil and all other 192 member states of the World Intellectual Property Organization (WIPO), at least as long as such suspicion exists.

In this paper, we formulate a deterministic mathematical model SEAIRB to study the dynamics behavior of COVID-19 pandemic. The model incorporates the impact of two strategies, health education and public sanitation, on the spread of the epidemic. Firstly, by using Routh-Hurwitz criteria, the disease-free equilibrium is locally asymptotically stable when the basic reproduction number does not exceed 1. Further, by using the comparison theorem, the global asymptotic stability of the disease-free equilibrium is obtained. Finally, numerical simulations are performed to verify the theoretical analysis and analyze the impact of different control strategies on the spread of the epidemic.

Omicron BF.7 became the predominant SARS-CoV-2 variant in Beijing after the adjustment of COVID-19 response strategies in December 2022. The ability of antibodies elicited by BF.7 infection to cross-react with SARS-CoV-2-like viruses is unknown. This study aimed to investigate the cross-reactive neutralizing antibodies against SARS-CoV-2-related pangolin coronavirus GX_P2V in sera from vaccinated and/or SARS-CoV-2 infected individuals. All vaccinated individuals who recovered from Omicron BF.7 breakthrough infections exhibited substantially higher levels of neutralizing antibodies against GX_P2V among collected subject populations (geometric mean titer [GMT] = 362). Uninfected individuals who received four-mixed-dose vaccines also demonstrated higher levels of neutralizing antibodies (GMT = 44) against GX_P2V than those who received two- or three-dose vaccines and those who recovered from wild type SARS-CoV-2. This finding highlights the significance of prior and hybrid booster vaccinations with wild-type SARS-CoV-2 vaccines in generating potent cross-protective immunity against future spillovers of SARS-CoV-2-like viruses.

Severe fever with thrombocytopaenia syndrome virus (SFTSV) and Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause the hyperproduction of inflammatory cytokines, which have pathological effects in patient including severe or fatal cytokine storms. To characterize the effect of SFTSV and SARS-CoV-2 infection on the production of cytokines in SFTS and COVID-19 patients, we performed an analysis of cytokines in SFTS and COVID-19 patients and also investigated the role of IL-10 in vitro studies: LPS-induced THP-1-derived macrophages, SFTSV infection of THP-1 cells, and SARS-CoV-2 infection of THP-1 cells. In this study, we found that levels of both IL-10 and IL-6 were significantly elevated, the level of TGF-β was significantly decreased and IL-10 was elevated earlier than IL-6 in severe and critical COVID-19 and fatal SFTS patients, and inhibition of IL-10 signalling decreased the production of IL-6 and elevated that of TGF-β. Therefore, the hyperproduction of IL-10 and IL-6 and the low production of TGF-β have been linked to cytokine storm-induced mortality in fatal SFTS and severe and critically ill COVID-19 patients and that IL-10 can play an important role in the host immune response to severe and critical SARS-CoV-2 and fatal SFTSV infection.

The study was designed to determine the prevalence and epidemiology of SARS-CoV-2 variants during the fifth wave of COVID-19 in selected districts of Punjab, Pakistan. The nasal swab samples (n=708)1 of suspected patients from various districts across Punjab were collected between December 2021 to April 2022. The genome extraction was done using an auto-extractor (Uni-medica) in the BSL-3 facility. Reverse-transcription real-time polymerase chain reaction (RT-PCR) was employed for viral detection and quantification. For the identification of SARS-CoV-2 variants, various mutations of spike protein were targeted using Multiplex PCR. The study’s results revealed the Omicron variant of concern (VOC) as the prevalent lineage of SARS-CoV-2 circulating in the selected regions of Punjab at the time of sampling. The VOC accounted for 90.01% of COVID-19 cases, followed by Delta (6.81%) and wild variant (3.80%). Prevalence of Omicron (VOC) was recorded higher in men (47.96%) as compared to women (42.05%). In addition, the highest percentage of VOC was observed in adults (47.39%) as compared to older people (32.07%) and young people (10.55%). This study highlighted the circulation of the Omicron variant during 5 th wave of COVID-19 in Punjab Province, Pakistan.

Background:The thrombopoietin receptor agonists (TRAs) were recommended for primary immune thrombocytopenia (ITP) during the pandemic of COVID-19. However, the incidence of thrombocytosis and thrombosis was sporadically reported in the chronic immune thrombocytopenia (CITP) patients receiving TRAs during the COVID-19 infection. Objective: With the local prevalence of COVID-19 in Dec 2022 in the Beijing area, we got more powerful evidence about the change in platelet (Plt) counts associated with COVID-19 infection. Methods: A signal center observational cohort study was performed from the beginning of Dec. 2022 to the end of Feb. 2023 to enroll CITP children treated with TRAs alone as the second-line treatment and suffering from the COVID-19 infection in Dec. 2022. The Plt counts before, during, and after COVID-19 infection were collected. Results: In total, 67 (34 males and 33 females) patients with 8.10 (2.15, 15.70) years of age were enrolled. Sixty-three patients who had responded to the TRAs showed a transient increase in Plt counts after the infection of COVID-19. The time of starting to increase was on Day 3(2,7), and to the peak level on Day 14(7,19) of infection with the peak Plt count was 289 (88, 1974)×10 9/L. With at least two months observation period from COVID-19 infection, the Plt counts of 100% (63/63) patients declined to the baseline on Day 25(14, 41). Conclusion: The phenomenon of transient increasing of Plt counts has been shown in the CITP children who have treatment responses to TRAs when suffering from COVID-19 infection.

In somatic cells, microRNAs (miRNAs) bind to the genomes of RNA viruses and influence their translation and replication. Here we demonstrate that a significant number of miRNA binding sites locate in the NSP4 region of the SARS-CoV-2 genome, and the intestinal human miRNAs exert evolutionary pressure on this region. Notably, in infected cells, NSP4 promotes the formation of double-membrane vesicles, which serve as the scaffolds for replication-transcriptional complexes and protect viral RNA from intracellular destruction. In three years of selection, the loss of many miRNA binding sites, in particular, those within the NSP4, has shaped the SARS-CoV-2 genomes to promote the descendants of the BA.2 variants as the dominant strains that define current momentum of the pandemics. Findings highlight the possibility that intestinal tissue may significantly impact evolution of the SARS-CoV-2 genome and may play a pivotal role in the long COVID.

COVID-19 infection and Leser-Trelat sign: is there an association?Farhad Handjaniab, Roya Radanfarab, Mozhdeh Sepaskhahab*, Niloofar Dehdari EbrahimicaMolecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, IranbDepartment of Dermatology, Shiraz University of Medical Sciences, Shiraz, IrancStudent Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran*corresponding author