Complications following COVID-19 infection or vaccination in Libyan International Medical University students and their Families

Coronavirus disease 2019 (COVID-19) caused by a novel strain of coronavirus belonging to the genus Beta coronavirus named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) emerged as a major pandemic worldwide. This contagious virus had spread in many different forms, and patients have demonstrated a wide range of symptoms, ranging from moderate to severe illness. This study aims to highlight the important associations between SARS-CoV-2 infection, vaccination, and possible complications at the Libyan International Medical University, Benghazi. This crosssectional survey was conducted among students and their families at Libyan International Medical University in Benghazi, Libya. Among the 100 participants, 72% were between the ages of 18 and 39. Up to (59%) of participants were men. As for the infection with COVID-19, 77% of participants were infected. Most of the participants had no chronic diseases (69%); however, the most common chronic disease was diabetes mellitus (13%). 82% of participants were vaccinated; the most common types of vaccines administered were Sinopharm and Sputnik V (24%). Following vaccination, 71% of participants had no COVID-19 infection, while 29% did get the infection. Regarding this study, after COVID-19 infection, 66% of participants had no complications; however, 17% had pulmonary complications, which was the most common complication among the participants. As for the complications following the vaccination, 81% of participants had none, while there were pulmonary and neurological complications in 7­6%. The results of the study showed that the most frequent complications noticed among the participants following the COVID-19 infection and vaccination were pulmonary and neurological complications.

Multisystem inflammatory syndrome in children in the context of coronavirus disease 2019 pandemic / 中国当代儿科杂志

Multisystem inflammatory syndrome in children (MIS-C) is a complex syndrome characterized by multi-organ involvement that has emerged in the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak. The clinical presentation of MIS-C is similar to Kawasaki disease but predominantly presents with fever and gastrointestinal symptoms, and severe cases can involve toxic shock and cardiac dysfunction. Epidemiological findings indicate that the majority of MIS-C patients test positive for SARS-CoV-2 antibodies. The pathogenesis and pathophysiology of MIS-C remain unclear, though immune dysregulation following SARS-CoV-2 infection is considered a major contributing factor. Current treatment approaches for MIS-C primarily involve intravenous immunoglobulin therapy and symptomatic supportive care. This review article provides a comprehensive overview of the definition, epidemiology, pathogenesis, clinical presentation, diagnosis, treatment, and prognosis of MIS-C.

Enhancing understanding of SARS-CoV-2 infection among individuals with Down syndrome: An integrative review

ABSTRACT BACKGROUND: Down syndrome (DS) is a non-rare genetic condition that affects approximately 1 in every 800 live births worldwide. Further, it is associated with comorbidities, anatomical alterations of the respiratory tract, and immunological dysfunctions that make individuals more susceptible to respiratory infections. OBJECTIVE: To systematize the current scientific knowledge about the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among individuals with DS. DESIGN AND SETTING: This integrative review was conducted at the Universidade Federal de São Carlos, São Paulo, Brazil. METHODS: This review was conducted in the following databases: the Virtual Health Library (Biblioteca Virtual em Saúde, BVS), PubMed, and Web of Science, using MeSH descriptors. The search included English or Portuguese studies published between January 1, 2020, and October 14, 2022. RESULTS: A total of 55 articles from 24 countries were selected, comprising 21 case-control or cohort studies, 23 case reports or series, and 11 narrative reviews or opinion studies. The articles were grouped into five categories: previous comorbidities, coronavirus disease 2019 (COVID-19) clinical features and evolution, cytokine storm and interleukins, living in institutions as a risk factor, and behavioral actions as a protective factor against SARS-CoV-2 infection. CONCLUSION: Individuals with DS are more susceptible to COVID-19 infection due to variables such as previous comorbidities, immunological factors, and their habitable environments. These aspects confer a higher risk of infection and an unfavorable clinical course. The precise pathways involved in the pathophysiology of COVID-19 in individuals with DS are not clear, thus requiring further studies. SYSTEMATIC REVIEW REGISTRATION: The Open Science Framework registered the research protocol (https://osf.io/jyb97/).

High-dose Vitamin C supplementation in the treatment of patients with COVID-19: A systematic review

Introduction: Vitamin C supplementation has been seen as a supportive treatment to control and prevent complications of COVID-19 by enhancing the immune response against infection. However, the effects of high doses of this vitamin are not yet fully understood. Objective: To analyze the effects of high-dose vitamin C in patients with COVID-19. Methods: This was a systematic review, using original studies published from April 2020 to November 2022 in PubMed, ScienceDirect, Scopus and Web of Science databases. The combination of descriptors registered in Medical Subject Headings (MeSH) used to search for articles were: (("vitamin C" OR "ascorbic acid") AND ("COVID-19" OR "SARS-CoV-2" OR "coronavirus")). Original articles of clinical trials conducted with patients diagnosed with COVID-19 and submitted to high-dose vitamin C supplementation were included. Results: Eligible studies included patients in intensive care units, wards, or outpatient clinics, who were given doses of vitamin C, ranging from 6,000 to 8,000 mg/day, with an average duration of 6.25 days of supplementation and mostly intravenous administration. A reduction in fever and myalgia was observed, as well as an improvement in oxygen saturation and lung impairment rate. Conclusion: The role of high-dose vitamin C in patients affected by COVID-19 requires further study, however, to date, the results have been promising for symptom reduction and improvement in lung function and oxygenation.

Introducción: La administración de suplementos de vitamina C se ha considerado un tratamiento de apoyo para controlar y prevenir las complicaciones del COVID-19 al mejorar la respuesta inmunitaria contra la infección. Sin embargo, los efectos de dosis elevadas de esta vitamina aún no se conocen en su totalidad. Objetivo: Analizar los efectos de altas dosis de vitamina C en pacientes con COVID-19. Métodos: Se trata de un estudio de revisión sistemática, utilizando artículos originales publicados desde abril de 2020 hasta noviembre de 2022 en las bases de datos PubMed, ScienceDirect, Scopus y Web of Science. Para la búsqueda de los artículos se utilizó la combinación de descriptores registrados en Medical Subject Headings (MeSH): (("vitamin C" OR "ascorbic acid") AND ("COVID-19" OR "SARS-CoV-2" OR "coronavirus")). Se incluyeron artículos originales de tipo ensayo clínico realizados con pacientes diagnosticados con COVID-19 y sometidos a suplementación con altas dosis de vitamina C. Resultados: Los estudios elegibles se realizaron con pacientes ingresados en unidades de cuidados intensivos, salas o ambulatorios, a los que se administraron dosis de vitamina C que oscilaban entre 6.000 y 8.000 mg/día, con una duración media de 6,25 días de suplementación y vía de administración mayoritariamente intravenosa. Se observó una reducción de la fiebre y las mialgias, además de una mejoría de la saturación de oxígeno y de la tasa de compromiso pulmonar. Conclusión: El papel de las dosis altas de vitamina C en pacientes afectados por COVID-19 requiere más estudios; sin embargo, hasta la fecha, los resultados han sido prometedores en cuanto a la reducción de los sintomas, y la mejora de la función pulmonar y la oxigenación.

Coronavirus disease 19 (COVID-19) and viral keratouveitis – unraveling the mystery

To demonstrate viral proteins/inflammatory cytokines in a patient with unilateral keratouveitis. Retrospective case report. A 70-year-old Asian-Indian male presented with acute onset of blurring of vision in the left eye (OS) of 2 days duration. He had was coronavirus disease 2019 (COVID-19)-positive 3 months earlier. He had undergone cataract surgery/retinal laser photocoagulation in both the eyes. The corrected distance visual acuity (CDVA) (Snellen) in the right eye (RE) (OD) and left eye (LE) (OS) was 20/20 and 20/80, respectively. OS showed decreased corneal sensation, Descemet’s folds, mild stromal edema, and fine and pigmented keratic precipitates with anterior chamber 1+ flare and 1+ cells. Fundus evaluation showed scattered laser marks in the OD and temporal sectoral laser marks in OS. He was diagnosed with viral keratouveitis in OS. Tear samples were collected on Schirmer’s strips and tear wash for mass spectrometry and cytokines, which had 368 and 451 viral proteins in the RE and LE, respectively, using nano liquid chromatography–mass spectrometry, which were more than controls. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and varicella zoster virus proteins were detected. Cytokine analysis using flow cytometer analysis showed higher inflammation in OS as compared to OD. The patient was treated with oral acyclovir and topical steroids and resulted in resolution of his keratouveitis. SARS-CoV-2 proteins were present in the tear sample 3 months after COVID-19. The presence of viral proteins does not indicate causality

COVID-19 in Children with West Syndrome: An Ambispective Study

Objectives To study the course of West syndrome (WS) and coronavirus disease-19 (COVID-19) in children with WS who contracted SARS-CoV-2 infection. Methods This ambispective study was conducted at a tertiary-care center in North India between December 2020 and August 2021 after approval from the Institute Ethics Committee. Five children with WS, positive for COVID-19 based on RT-PCR, fulflled the inclusion criteria. Results One child with COVID-19 during the frst wave was retrospectively included while four children (of the 70 children screened) were prospectively enrolled. The median age at onset of epileptic spasms was 7 mo (2 boys), and that at presentation with COVID-19 was 18.5 mo. Three had underlying acquired structural etiology. Three were in remission following standard therapy, while two had ongoing spasms at the time of COVID-19 illness. During the illness, two of those in remission continued to be in remission while one child had a relapse. The children with ongoing epileptic spasms had variable course [one had persistent spasms and other had transient cessation lasting 3 wk from day 2 of COVID-19 illness, but electroencephalography (on day 8 of COVID-19 illness) continued to show hypsarrhythmia]. Fever was the most typical symptom (and sometimes the only symptom) of COVID-19, with a duration ranging from 1–8 d. Two children had moderate COVID-19 illness requiring hospitalization, while the rest had a mild illness. All the afected children had complete recovery from COVID-19. Conclusion The severity of COVID-19 illness in children with WS is often mild, while the subsequent course of WS is variable.

Pleural empyema after COVID-19: A delayed presentation

Globally, the number of coronavirus disease-2019 (COVID-19) cases and deaths shows a declining trend since a peak in January 2022. For now, the pandemic phase looks to be ended, until a severe new variant may trigger another wave. At present, in India, small pockets of COVID-19 cases and post-COVID complications are still being reported. Therefore, physicians should remain vigilant about the atypical presentations and potential delayed or long-term complications of SARS-CoV-2 infection, even in individuals who had a mild COVID-19 infection. Here, we present the case of a 52-year-old male patient with a history of hypertension, who is a non-smoker and developed culture-negative pleural empyema 7 months after a mild COVID-19 infection. The patient was successfully treated with antibiotics and early video-assisted thoracoscopic surgery

Awareness, perceptions, and attitude towards Coronavirus disease 2019 vaccine among pregnant women in India: A cross-sectional study

Introduction: The present study was conducted to explore the awareness and perception of the coronavirus disease 2019 (COVID-19) vaccine among pregnant women. Material and Methods: A descriptive cross-sectional study was conducted from September 01, 2021, to September 28, 2021, among 301 pregnant women aged 18–35 years at antenatal care outpatient department in a tertiary care hospital of Western Maharashtra. Results: On assessing the knowledge and awareness score, the mean score (± standard deviation) was 7.83 ± 1.2 out of 16. A total of 176 (58.5%) had good scores(?8). There was no statistically significant association between knowledge and awareness scores and the level of education, type of residence, and age or with weeks of gestation. Although the overall awareness of study participants was satisfactory, 177 (58.8%) felt that COVID-19 vaccines should be avoided during the first trimester. Interestingly, 45 (15.3%) felt that vaccines should not be given during menstruation. There were misconceptions about perceived contraindication, with 81(26.9%), 50(16.6%) and 43(14.4%) responding that diabetes, hypertension and heart disease are contradicts respectively. Interestingly, a total of 52 (17.3%) responded as likely when enquired whether the present vaccine can cause infertility. Similarly, about 62% of study participants felt that the vaccine might alter the DNA. Conclusion: The present study revealed good overall knowledge and awareness about the COVID-19 vaccine among pregnant with certain misconceptions. The findings suggest that immediate health education programs, risk communication, and correct information should be disseminated by respective health authorities.

A review of venous thromboembolism in India

Venous thromboembolism (VTE), which entails the formation of a thrombus (blood clot) in a vein, has a significant disease burden worldwide. While VTE has traditionally been considered to predominantly affect Caucasian populations, recent studies have indicated a gradual shift in the disease burden towards Asian populations, with added significance of it being a key driver of post-operative mortality. It is imperative to develop a sound understanding of the various factors that affect VTE in stratified local populations. However, there is a glaring paucity of quality data on VTE and its ramifications among Indians - both in terms of quality of life and cost of healthcare. This review aims to throw light on the disease burden, epidemiology, risk factors, environmental factors, food and nutrition that plays a key role in VTE. We also explored the association of VTE with coronavirus disease 2019 to grasp the interplay between the two most significant public health crises of our time. It is vital to place a special emphasis on future research on VTE in India to plug the gaps, which exist in our current knowledge of the disease, particularly with respect to Indian population

Comparative study of the clinicoepidemiological profile of COVID-19 patients of first wave and second wave admitted in a tertiary care teaching hospital in Nadiad, Gujarat, India

Background: According to other studies, second wave was different as compared to the first wave in clinical outcomes and laboratory parameters. Aims and Objectives: We aimed to compare the clinicoepidemiological features and their effect on mortality in coronavirus disease-2019 (COVID-19) patients of first wave versus second wave. Materials and Methods: We carried out cross-sectional, observational, and retrospective study among two groups of COVID-19 patients of first and second wave. Each group contains a 135 patients of COVID-19 admitted at our hospital. We analyzed the demographic profile, clinical features, comorbidities, and inflammatory markers. Results: In our study, majority patients were male (67%). Majority number of the patients were between 18 and 60 years of age in both the groups. Presenting complaint of shortness of breath was significantly higher in second wave and sore throat was significantly higher in first wave. SpO2 on admission was significantly lower in second wave (93% vs. 98%). Median value of C-reactive protein (6.865 vs. 2.805), neutrophil-leucocyte ratio (4.647 vs. 2.917), and D-dimer (679.5 vs. 450) were significantly higher in second wave. Second wave had significantly higher mortality as compared to first wave (18.5% vs. 4.4%). However, level of D-dimer was found significantly higher in patients who died during first wave (6820 vs. 848). Higher mortality was seen in male patients of second wave. Conclusion: Overall higher mortality was seen during the second wave which was supported by increased in the inflammatory markers. Delta variant, late admission, increased demand of oxygen support, and intensive care unit beds may have led to higher mortality.

Bilateral acute depigmentation of the iris determined in two cases after COVID-19 infection

Bilateral acute depigmentation of the iris (BADI) is a rare disease characterized by iris atrophy. Although it can be self-limiting, it is sometimes progressive and can lead to glaucoma and severe vision loss. Two female patients were admitted to our clinic because of a change in iris color following coronavirus disease 2019 (COVID-19) infection. After the exclusion of other etiologies in the eye examination, BADI was diagnosed in both cases. Thus, it was shown that COVID-19 may also be involved in the etiology of BADI.

Lipschütz acute vulvar ulcer related to COVID-19 vaccination: First case report in South America / Úlcera vulvar aguda de Lipschütz relacionada con la vacunación por COVID-19: primer caso notificado en Sudamérica

Lipschütz ulcer is a non-sexually transmitted genital lesion of unknown etiology, which presents as a painful vulvar ulcer. Lipschütz ulcers have been described in most continents. This is the first case reported in Peru and South America. We present the case of a 33-year-old female patient with a Lipschütz ulcer after being vaccinated with the second dose of the AstraZeneca COVID-19 vaccine. She reported having had only one sexual partner in her lifetime. Laboratory results were negative for herpes simplex 2, Cytomegalovirus, Toxoplasma gondii, Epstein-Barr virus, and syphilis. The patient received symptomatic treatment. Ten days after the onset, the patient was significantly better during follow-up. This case report displays a potential adverse effect of the AstraZeneca COVID-19 vaccine as a Lipschütz ulcer triggered by the host humoral immune response. However, further research is needed to establish the causal relationship between these two.

La úlcera de Lipschütz es una lesión genital no transmitidas por vía sexual de etiología desconocida, se presenta como una úlcera vulvar muy dolorosa. Las úlceras de Lipschütz se han descrito en la mayoría de los continentes. Este es el primer caso que se reporta en Perú y Sudamérica. En este reporte de caso se presentauna paciente de 33 años con una úlcera de Lipschütz luego de haber sido vacunada con la segunda dosis de la vacuna AstraZeneca COVID-19. Refirió haber tenido una sola pareja sexual a lo largo de su vida. Los resultados de laboratorio fueron negativos para herpes simplex 2, Citomegalovirus, Toxoplasma gondii, virus de Epstein-Barr y sífilis. La paciente recibió tratamiento sintomático. Diez días después, durante el seguimiento, la paciente estaba significativamente mejor. Este reporte de caso expone un potencial efecto adverso de la vacuna AstraZeneca COVID-19, en forma de úlcera de Lipschütz, desencadenado por la respuesta inmune humoral del huésped. Sin embargo, es necesario realizar más investigación para establecer la relación causal entre ambos.

After action review of the COVID-19 pandemic response in North West province, South Africa

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused coronavirus disease 2019 (COVID-19) pandemic with major disruptions globally. Northwest Province Department of Health (NWDoH) in South Africa set up comprehensive epidemiological emergency response plans for preventing, finding, containing and stopping the spread of COVID-19 in accordance with the National Disaster Management Act. Objectives: This After-Action Report (AAR) describes the provincial response to the pandemic from September 2020 to October 2022. Method: The AAR was conducted using the World Health Organization AAR methodology. Focus groups discussed five items: coordination, leadership and governance; epidemiology, surveillance and laboratory; case management and continuity of essential services; risk communication and community engagement and COVID-19 vaccination. Results: The timely establishment and activation of provincial intergovernmental and intersectoral coordinating structures led to effective coordination, resource mobilisation, leadership, decision-making and intervention. The effective communication in the department and other stakeholders resulted in improved surveillance data quality, timelier response and increased ownership of data. Dissemination, training and implementation of case management protocols ensured standardised case management. The multi-channel information dissemination targeting different audiences empowered people with real-time knowledge on the infection and encouraged health-seeking behaviours. Conclusion: The AAR demonstrated the importance of coordinated epidemiological, laboratory and communication response that requires significant public health reserve capacity in peacetime for rapid expansion in an emergency. Contribution: This review contributes to the body of knowledge emerging from the COVID-19 pandemic and provides guidance on enhanced public health response to future emergencies.

Acute and subacute oral toxicity characterization and safety assessment of COVID organics® (Madagascar's Anti­COVID Herbal Tea) in animal models

Introduction: Coronavirus disease 2019 (COVID 19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2. No drug has been generally approved as safe and effective for the treatment of COVID 19. Several therapeutic agents such as COVID Organics® (CVO) have been explored as treatment options. CVO is an herbal tea composed of 62% of Artemisia annua and 38% of other plants. There is presently no existing scientific report and data on the safety and efficacy of CVO herbal drug. Thus, acute and subacute toxicity studies were undertaken to evaluate the safety and toxicity of CVO on short and long term usage in animal models. Materials and Methods: Phytochemical and nutritional compositions of CVO were determined using standard methods. Acute oral toxicity was investigated using female Swiss albino mice (three per group). While subacute oral toxicity was done using female and male Swiss albino rats (five per group). The animals were administered 2000 mg/kg, 5000 mg/kg, therapeutic dose; 5500 mg/kg and supratherapeutic dose; 11,000 mg/kg of CVO herbal product. The control group received water ad libitum. The oral toxicity studies were done in accordance with Organization for Economic Corporation and Development guidelines. The experimental protocol was approved by the Institutional Animal Care and Use Committee, Nigerian Institute of Medical Research (Ethics No. IRB/17/043). Results: CVO is rich in antioxidants: flavonoids(10.3%), tannins(29.1%), and phenolics(434.4 mg). It contains proteins (33.8%), carbohydrates (34.5%), fat (6.8%), and fiber (0.5%). In the acute toxicity study, no mortality was recorded in all the treated and untreated groups. The lethal dose of CVO is >5000 mg/kg body weight. The hematological, biochemical, lipid profile, and histologic parameters were all normal at therapeutic doses when compared to the control group. Conclusion: The acute and subacute oral toxicity studies revealed that CVO is not toxic. The specific organ toxicity evaluations also indicated that CVO has no toxic effects on blood parameters and vital organs structure and function at therapeutic dose. Thus, CVO is safe for short and long term usage. We recommend that CVO should be subjected to efficacy studies to investigate whether it is effective for COVID 19 treatment as claimed by the manufacturer.

Compassion fatigue among nurses assigned to COVID-19 facilities: A constructivist grounded theory

Background@#The Coronavirus Disease (COVID-19) pandemic significantly disrupted regular health care services, mainly in the hospitals. Nurses soldiering on the battlefront of care of disaster response in the Philippines during the disease outbreak are at high risk of developing rapid-onset compassion fatigue. Notably, research is still needed to investigate the impact of compassion fatigue on various clinical areas and further develop a theory of compassion fatigue within the nursing context. @*Objectives@#The study explored the concept of compassion as experienced by nurses directly caring for COVID-19 patients. The study further explored the experiences of nurses on compassion fatigue. @*Methods@#This study employed qualitative methodology, specifically the constructivist grounded theory. @*Results@#Thirty-four participants were included in the study. The narratives and voices of the nurses unfolded the following themes: (1) Acts of Compassion, (2) COVID-19 Pandemic: Nursing Challenges and Detours, (3) Nurses’ Compassion Fatigue, (4) Narratives of Opportunities: Thriving at the outset of COVID-19. All four concepts are linked to the multidimensional concept of compassion fatigue. A substantive theory, “Remon’s CF Theory in Nursing," is proposed based on the grounded experiences of nurses caring for COVID-19 patients related to compassion fatigue. @*Conclusion@#Compassion Fatigue (CF) is a psycho-social phenomenon and occupational hazard affecting nurses directly caring for or in contact with COVID-19 patients. CF is a process that develops over time brought by prolonged enactment of compassion, the experience of empathic distress, and concurrence of organizational, contextual, and psychosocial factors. Nurses' CF can potentially affect safety and lead to poor nursing care, compromised work relations, and burnout. Nurse leaders' organizational and leadership commitment and support through up-to-date policies and continuous research on the topic are necessary to regain compassion among nurses. Likewise, reframing nurse compassion fatigue as an organizational and collective problem provides the larger perspective to further improve clinical practice and nurses’ welfare. @*Recommendations@#Nurse leaders, hospital and COVID-19 facility administrators must ensure specific policies and priorities that address issues causing and fueling nurse compassion fatigue, including frequency of exposure to traumatic events, lack of resources, and inadequate support system. The study further suggests conducting quantitative research to test the proposed theory and explore the relationship between organizational, psychosocial, and environmental context, compassion fatigue, and compassion-driven factors.

Integrated Chinese and Western Medicine for Tuberculosis and Severe Malnutrition with Coronavirus Disease 2019（Critical Type）： A Case Report / 中医杂志

We reported a case of a patient dignosed as tuberculosis and severe malnutrition with coronavirus disease 2019 （critical type） treated with a combination of Chinese medicine and Western medicine. Through the retrospective analysis of the diagnosis and treatment process of this patient， on the basis of Chinese medicine's understanding of the etiology and pathogenesis of “old state” and “deficient state”， the critical coronavirus pneumonia combined with pulmonary tuberculosis and severe malnutrition was mostly due to the physical condition and the invasion of epidemic toxin， resulting in dysfunctions of the internal organs such as the lungs， spleens， kidneys and other organs. Based on the understanding of the cause and mechanism of the coronavirus disease， the treatment combined Chinese and Western medical therapies was given. The western medicine was used with the main treatments of oxygen therapy， anti-viral， intestinal nutritional support， and anti-coagulation， while the Chinese medicine was used by tonifying qi， blood， yin， and yang， warming yang and dissipating cold， and clearing heat and dampness， then tonifying qi， nourishing yin and eliminating heat， in which tonifying middle and replenishing qi ran through the whole process. The integrated treatment eventually improved the patient's symptoms and accelerated the negative conversion of nucleic acid of the coronavirus.

TONG Xiaolin's Cold-Damp Epidemic Differentiation and Treatment Concepts and Diagnostic and Therapeutic Key Points / 中医杂志

Building on a clear understanding of the diagnosis and treatment patterns for cold-damp epidemics， and incorporating the insights of Academician TONG Xiaolin regarding the differentiation and treatment of such epidemics， this article have distilled the key diagnostic principles. These principles primarily entail observing color and pulse， initially distinguishing between yin and yang， with treatment focusing on dispelling cold and dampness. A comprehensive approach is adopted throughout treatment， with a combination of overall strategies and tailored treatments that evolve in line with the patient's condition. In critical and severe cases， particular attention is given to aspects such as sweating， pulse analysis， and consciousness， preventing the pathogen from penetrating deeply. Efforts are made to open and close organ networks， expelling external pathogens without fixating on resolving constipation. The dosage and efficacy of herbal remedies are adjusted based on individual circumstances and clinical symptoms. The objective is to eliminate pathogens comprehensively， while being vigilant against relapses， ultimately achieving a full recovery. This overview of the thought processes and clinical principles for diagnosing and treating cold-damp epidemics will guide precise clinical practices and provide a theoretical foundation for the involvement of traditional Chinese medicine in epidemic prevention and treatment.

Verification of detection method for multiple pathogens in plasma of convalescent patients with Coronavirus Disease 2019 / 中国生物制品学杂志

@#Objective To systematically verify the detection method for multiple pathogens in plasma of convalescent patients(CPs)with Coronavirus Disease 2019(COVID-19).Methods According to the actual situation of plasma samples and the requirements of kit,the molecular biological detection method for multiple pathogens in plasma of CPs with COVID-19 was systematically verified for specificity,reproducibility,intermediate precision and limit of detection(LOD),and confirmed for applicability by detecting 50 plasma samples of CPs with COVID-19.Results The results of interference test and cross test showed that the detection of positive samples and negative samples were not affected;The RSDs of melting temperature values(Tm)of the positive control four pathogens by the same or different test personnels at different time under the same test conditions were 0.07%,0.14%,0.07%,0.14% and 0.06%,0.23%,0.23%,0.20%,and those of internal control(IC)and amplification control(AC)1 and 2 were 0.07%,0.01%,0.07%,0.14% and 0.11%,0.10%,0.15%,0.22%,respectively.Meanwhile,the RSDs of reproducibility and intermediate precision were less than 15% and20% respectively,which met the requirements;The minimum LOD of 22 pathogens were determined;No pathogen was detected in 50 plasma samples of CPs with COVID-19.Conclusion The method for detecting pathogens in plasma of CPs with COVID-19 was specific,stable,reliable and reproducible,which was suitable for the detection of pathogens in plasma of CPs with COVID-19.

Enhancing the Effectiveness of Surveillance Systems in Pacific Island Countries as Early Warning Systems for Detecting and Responding to COVID-19 Outbreaks: Key Strategies and Recommendations

@#The coronavirus disease 2019 (COVID-19) pandemic has uncovered the need for health systems to be strengthened in order to be able to respond quickly to any potential future outbreaks. In response, the Pacific Syndromic Surveillance System (PSSS) is currently being used by many countries within the Pacific Islands for tracking and addressing infectious disease outbreaks, including COVID-19. To maximise its usefulness as an early warning system, investments must be made in strengthening data quality, data sharing, health facility capacity, technology, and ongoing evaluation of surveillance systems. Doing so will ensure that the PSSS and other surveillance systems can remain effective tools for monitoring and respond to infectious disease outbreaks in the Pacific Islands

Early prediction of severe COVID-19 in patients with Sjögren's syndrome / 北京大学学报(医学版)

OBJECTIVE@#To investigate the predictive value of blood cell ratios and inflammatory markers for adverse prognosis in patients with primary Sjögren's syndrome (PSS) combined with coronavirus disease 2019 (COVID-19).@*METHODS@#We retrospectively collected clinical data from 80 patients with PSS and COVID-19 who visited the Rheumatology and Immunology Department of the First Affiliated Hospital of Nanchang University from December 2022 to February 2023. Inclusion criteria were (1) meeting the American College of Rheumatology (ACR) classification criteria for Sjögren's syndrome; (2) confirmed diagnosis of COVID-19 by real-time reverse transcription polymerase chain reaction or antigen testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); (3) availability of necessary clinical data; (4) age > 18 years. According to the clinical classification criteria of the "Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (trial the 10th Revised Edition)", the patients were divided into the mild and severe groups. Disease activity in primary Sjögren' s syndrome was assessed using the European League Against Rheumatism (EULAR) Sjögren' s syndrome disease activity index (ESSDAI). Platelet-lymphocyte ratio (PLR), C-reactive protein-lymphocyte ratio (CLR), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and other laboratory data were compared between the two groups within 24-72 hours post-infection.@*RESULTS@#The mild group consisted of 66 cases with an average age of (51. 52±13. 16) years, and the severe group consisted of 14 cases with an average age of (52.64±10.20) years. Disease activity, CRP, platelets, PLR, and CLR were significantly higher in the severe group compared with the mild group (P < 0.05). Univariate analysis using age, disease activity, CRP, platelets, PLR, and CLR as independent variables indicated that disease activity, CRP, PLR, and CLR were correlated with the severity of COVID-19 (P < 0.05). Multivariate logistic regression analysis further confirmed that PLR (OR=1.016, P < 0.05) and CLR (OR=1.504, P < 0.05) were independent risk factors for the severity of COVID-19 in the critically ill patients. Receiver operator characteristic (ROC) curve analysis showed that the area under the curve (AUC) for PLR and CLR was 0.708 (95%CI: 0.588-0.828) and 0.725 (95%CI: 0.578-0.871), respectively. The sensitivity for PLR and CLR was 0.429 and 0.803, respectively, while the highest specificity was 0.714 and 0.758, respectively. The optimal cutoff values for PLR and CLR were 166.214 and 0.870, respectively.@*CONCLUSION@#PLR and CLR, particularly the latter, may serve as simple and effective indicators for predicting the prognosis of patients with PSS and COVID-19.