Misdiagnosis of COVID-19 infection before molecular confirmation in Sulaimaniyah City, Iraq.

BACKGROUND: During the last 2 years, in the Kurdistan Region, Northern Iraq, there were thousands of COVID-19 cases that have not been reported officially, but diagnosed and confirmed by private laboratories and private hospitals, or clinicians based on typical clinical signs, as well as few people using home self-test after appearing of some flu-like clinical symptoms. Thus, this study aims to assess the misdiagnosis and mismanagement of cases before COVID-19 confirmation. METHODS: This study enrolled 100 consecutive patients who visited an outpatient clinic of Shar Hospital that had symptoms highly suspicious of COVID-19 infection while misdiagnosed previously to have other types of disease. Detailed questionnaires were filled for all studied patients, including age, gender, main presenting symptoms, and duration of these symptoms with the following questions: who made the false diagnosis, depending on which diagnostic test the false diagnosis was made, which medication was used for the false diagnosis, who prescribed those medications, and how long those medications were used. They were investigated by RT-PCR on their nasopharyngeal swab for confirmation. RESULTS: Most of the false diagnoses were typhoid (63%), influenza (14%), pneumonia (9%), gastroenteritis (5%), common cold (4%), brucellosis (4%), and meningitis (1%). Regarding the false diagnosis of cases, 92% were made by non-physician healthcare workers, and only 8% were made by physicians. All false diagnoses with typhoid, gastroenteritis, and common cold were made by non-physician healthcare workers, together with about half of the diagnosis of pneumonia and brucellosis, with statistically significant results (P < 0.001). CONCLUSIONS: We realized that some patients had been misdiagnosed before the COVID-19 infection confirmation. Their health conditions improved drastically after correct diagnosis and treatment, and this research is considered the first research to be conducted in Iraq in this regard.

Correlation of SARS-CoV-2 infection severity with ABO blood groups and RhD antigen: a case-control study.

OBJECTIVE: The role of ABO types and RhD antigen in coronavirus disease 2019 (COVID-19) severity has been investigated in several recent studies. Thus, the objective of this study was to identify the relationship of ABO and RhD types with symptomatic COVID-19 disease and determine the groups associated with an increased risk of hospitalization. METHODS: This observational case-control study was performed in 530 Iraqi-Kurdish patients with COVID-19. Among them, 184 were severe cases that required hospitalization, while 346 were mild to moderate cases that were treated at home. ABO and RhD antigen groups were compared between cases and 1698 control records from 1 year before the pandemic. The diagnosis of COVID-19 was based on real-time polymerase chain reaction tests and high-resolution chest computed tomography scans with the typical clinical presentation. RESULTS: There were no significant differences in ABO and RhD antigen distributions between the COVID-19 cases and non-COVID controls. No ABO group was associated with the risk of hospitalization as a marker of the severity of infection. CONCLUSIONS: There was no significant association between symptomatic COVID-19 disease and any ABO group or RhD antigen type. No impact of ABO groups on hospitalization was documented.

A comprehensive review about immune responses and exhaustion during coronavirus disease (COVID-19).

Coronavirus disease (COVID-19) is a viral infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. The infection was reported in Wuhan, China, in late December 2019 and has become a major global concern due to severe respiratory infections and high transmission rates. Evidence suggests that the strong interaction between SARS-CoV-2 and patients' immune systems leads to various clinical symptoms of COVID-19. Although the adaptive immune responses are essential for eliminating SARS-CoV-2, the innate immune system may, in some cases, cause the infection to progress. The cytotoxic CD8+ T cells in adaptive immune responses demonstrated functional exhaustion through upregulation of exhaustion markers. In this regard, humoral immune responses play an essential role in combat SARS-CoV-2 because SARS-CoV-2 restricts antigen presentation through downregulation of MHC class I and II molecules that lead to the inhibition of T cell-mediated immune response responses. This review summarizes the exact pathogenesis of SARS-CoV-2 and the alteration of the immune response during SARS-CoV-2 infection. In addition, we've explained the exhaustion of the immune system during SARS-CoV-2 and the potential immunomodulation approach to overcome this phenomenon. Video Abstract.

A Review on the Antiviral Activity of Functional Foods Against COVID-19 and Viral Respiratory Tract Infections.

Due to the absence of successful therapy, vaccines for protection are continuously being developed. Since vaccines must be thoroughly tested, viral respiratory tract infections (VRTIs), mainly coronaviruses, have seriously affected human health worldwide in recent years. In this review, we presented the relevant data which originated from trusted publishers regarding the practical benefits of functional foods (FFs) and their dietary sources, in addition to natural plant products, in viral respiratory and COVID-19 prevention and immune-boosting activities. As a result, FFs were confirmed to be functionally active ingredients for preventing COVID-19 and VRTIs. Furthermore, the antiviral activity and immunological effects of FFs against VRTIs and COVID-19 and their potential main mechanisms of action are also being reviewed. Therefore, to prevent COVID-19 and VRTIs, it is critical to identify controlling the activities and immune-enhancing functional food constituents as early as possible. We further aimed to summarize functional food constituents as a dietary supplement that aids in immune system boosting and may effectively reduce VRTIs and COVID-19 and promote therapeutic efficacy.

Recent Advancements on COVID-19: A Comprehensive Review

Over the last few decades, there have been several global outbreaks of severe respiratory infections. The causes of these outbreaks were coronaviruses that had infected birds, mammals and humans. The outbreaks predominantly caused respiratory tract and gastrointestinal tract symptoms and other mild to very severe clinical signs. The current coronavirus disease-2019 (COVID-19) outbreak, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a rapidly spreading illness affecting millions of people worldwide. Among the countries most affected by the disease are the United States of America (USA), India, Brazil, and Russia, with France recording the highest infection, morbidity, and mortality rates. Since early January 2021, thousands of articles have been published on COVID-19. Most of these articles were consistent with the reports on the mode of transmission, spread, duration, and severity of the sickness. Thus, this review comprehensively discusses the most critical aspects of COVID-19, including etiology, epidemiology, pathogenesis, clinical signs, transmission, pathological changes, diagnosis, treatment, prevention and control, and vaccination.

Pediatric COVID-19 infection in Sulaimaniyah Governorate, Iraq.

BACKGROUND: COVID-19 is a severe acute respiratory syndrome caused by SARS-CoV-2. OBJECTIVE: To study the demographic and clinical presentations of COVID-19 with their types including MIS-C and Kawasaki among children who were admitted to Doctor Jamal Ahmad Rashid Pediatric Teaching Hospital (DJARPTH) at Sulaimaniyah city, Iraq. PATIENTS AND METHODS: A prospective cohort study was conducted from June to December 2020 in which 50 cases suspected of COVID-19 were enrolled in the study that was admitted at the first visit to the emergency department of DJARPTH and their age ranged between 3 months to 14 years. Then, the collected data were divided into 3 groups: COVID-19, Kawasaki disease (KD), and MIS-C. RESULTS: The fever was the most common presented symptom in all cases with COVID-19 regardless of the severity. COVID-19 may be presented as KD as well as MIS-C. There is an increase in the number of Kawasaki cases since 2019 by 6.7 fold due to the increased number of COVID-19 cases in children. Death was more related to MIS-C and primary COVID-19 diseases. Most COVID-19 cases presented with pericardial effusion; although coronary involvement and LV dysfunction mostly seen with MIS-C cases. CONCLUSION: COVID-19 is not uncommon in pediatric patients and it presents as either primary, MIS-C, and KD. Most of the deaths and ICU outcomes were related to MIS-C presentations.

The lethal internal face of the coronaviruses: Kidney tropism of the SARS, MERS, and COVID19 viruses.

The kidney is one of the main targets attacked by viruses in patients with a coronavirus infection. Until now, SARS-CoV-2 has been identified as the seventh member of the coronavirus family capable of infecting humans. In the past two decades, humankind has experienced outbreaks triggered by two other extremely infective members of the coronavirus family; the MERS-CoV and the SARS-CoV. According to several investigations, SARS-CoV causes proteinuria and renal impairment or failure. The SARS-CoV was identified in the distal convoluted tubules of the kidney of infected patients. Also, renal dysfunction was observed in numerous cases of MERS-CoV infection. And recently, during the 2019-nCoV pandemic, it was found that the novel coronavirus not only induces acute respiratory distress syndrome (ARDS) but also can induce damages in various organs including the liver, heart, and kidney. The kidney tissue and its cells are targeted massively by the coronaviruses due to the abundant presence of ACE2 and Dpp4 receptors on kidney cells. These receptors are characterized as the main route of coronavirus entry to the victim cells. Renal failure due to massive viral invasion can lead to undesirable complications and enhanced mortality rate, thus more attention should be paid to the pathology of coronaviruses in the kidney. Here, we have provided the most recent knowledge on the coronaviruses (SARS, MERS, and COVID19) pathology and the mechanisms of their impact on the kidney tissue and functions.

COVID-19 severity in relation to sociodemographics and vitamin D use.

Most COVID-19 cases are treated as outpatients, while the majority of studies on COVID-19 focus on inpatients. Little is known about the self-reporting and self-rating of the disease's symptoms, and the associations of prophylactic use of dietary supplements with COVID-19 severity have not been addressed. The aims of this study are to evaluate COVID-19 severity and to relate them to sociodemographic characteristics and prophylactic dietary supplements. An observational patient-based study conducted through an online questionnaire on recovered COVID-19 patients. The patients were assessed for several severity parameters, sociodemographic parameters, and prophylactic dietary supplement use. A total of 428 patients were evaluated. Age and presence of comorbidities had positive associations with the severity parameters. The severe infection group had the highest proportion of patients stressed about COVID-19 (P < 0.05). Cigarette, but not hookah, smoking was significantly associated with less severe symptoms. Vitamin D negatively predicted disease severity (P < 0.05). In conclusion, stress, age, and presence of comorbidities were the most important positive predictors of COVID-19 severity, while prophylactic vitamin D use and smoking were significant negative predictors. The use of protective measures and other prophylactic dietary supplements was not significantly associated with symptom severity.

The transmission modes and sources of COVID-19: A systematic review.

The current rampant coronavirus infection in humans, commonly known as COVID-19, a pandemic that may cause mortality in humans, has been declared a global emergency by the World Health Organization (WHO). The morbidity and mortality rates due to the pandemic are increasing rapidly worldwide, with the USA most affected by the disease. The source COVID-19 is not absolutely clear; however, the disease may be transmitted by either by COVID-19-positive individuals or from a contaminated environment. In this review, we focused on how the COVID-19 virus is transmitted in the community. An extensive literature search was conducted using specific keywords and criteria. Based on the published report, it is concluded that COVID-19 is primarily transmitted human-to-human via oral and respiratory aerosols and droplets with the virus-contaminated environment play a lesser role in the propagation of disease. Healthcare providers and the elderly with comorbidities are especially susceptible to the infection.

The strategy for controlling COVID-19 in Kurdistan Regional Government (KRG)/Iraq: Identification, epidemiology, transmission, treatment, and recovery.

This study has carried out a mini-review on first wave of COVID-19 infection and its control by the Kurdistan Regional Government (KRG)/Iraq. COVID-19 infection, which was named by the International Committee of Taxonomy of Viruses (ICTV) as SARS-CoV-2, is a newly identified coronavirus. The last century has seen the outbreak of numerous life-threatening human pathogens including Nipah, Ebola, Zika, Chikungunya, Middle East respiratory syndrome coronavirus (MERS-CoV), severe acute respiratory syndrome coronavirus (SARS-CoV), and more recently a novel coronavirus has been observed. COVID-19 infection has so far spread to more than 186 countries around the world and KRG/Iraq has not been free from this virus. In this survey, the control of COVID-19 infection in KRG as a part of Iraq is discussed in detail. The methods of identification as well as the drugs that are currently in common use to reduce the wide distribution of COVID-19 infection and their effects in countries around the world are considered. So far, 714 positive cases have been reported by the ministry of health in Kurdistan Region Government-Iraq (KRG), among which there have been only 8 deaths, and 420 cases have recovered. Those who died had a previous history of a chronic disease such as diabetes, hypertension, heart disease, and hypercholesteremia. Alternative medicine based on natural green methods has been widely used by Kurdish people in past years for treatment of strong coughs. In the present study, some natural products which are cost free and effective in enhancing the body's resistance against the virus are considered. A surprising finding is that the patients in KRG have not in general had a severe cough, flu, or fever. The possible explanation may relate to the patients' strong immune systems, since none of them had a history of using alcohol and drugs, or of chronic disease. The epidemiology and transmission of the virus are discussed as well.