Investigating the diagnostic and prognostic value of anti-SARS-CoV-2 Spike IgG/IgM ELISA tests in patients infected with coronavirus Delta variant.

Aim: This study aimed to investigate the diagnostic and prognostic value of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Spike IgG/IgM antibodies in patients infected with coronavirus Delta variant. Methods: This analytical observational study included 270 unvaccinated patients (aged ≥18 years) diagnosed with coronavirus disease 2019 (COVID-19) Delta variant who referred to Emergency Department of our hospital. The serum levels of anti-SARS-CoV-2 Spike IgG and IgM were measured by indirect ELISA. Main measured outcomes included anti-SARS-CoV-2 Spike IgG and IgM, chest computed tomography (CT) severity score, clinical and laboratory findings which were prospectively evaluated throughout the study period. Results: The IgM levels in critical patients were significantly higher than non-critical patients (p<0.05). But the mean level of IgG in critical patients was not significantly different from its level in non-critical patients (p>0.05). However, a significant positive correlation was observed between the levels of both antibodies and chest CT severity score (p<0.0001); this implies that their levels may reflect the degree of lung involvement. The IgM level on 15th-16th days after symptoms onset was significantly associated with the hazard of death even after adjusting for all other factors (adjusted HR (95%CI):1.28(1.014_1.63), p=0.03), whereas IgG was not (p>0.05). The survival probability among patients with IgM level ≥8.67 RU/ml (34.2%) was significantly lower than those with IgM level <8.67 RU/ml (99.5%, p=0.0001). Conclusions: Anti-SARS-CoV-2 Spike IgM antibody was significantly associated with the disease severity and risk of death in unvaccinated patients infected with coronavirus Delta variant. However, further large-scale investigations on diverse infected populations are required to precisely determine the diagnostic/prognostic value of these antibodies.

A randomized clinical trial evaluating the immunomodulatory effect of convalescent plasma on COVID-19-related cytokine storm.

Evaluating the effect of convalescent plasma (CP) on some cytokine storm indices in severe COVID-19 patients. Totally, 62 patients were randomly assigned into two groups for this clinical trial. Patients in the intervention group received one unit (500 mL) plasma on the admission day plus standard drugs while the controls merely received standard treatments. Eventually, primary and secondary outcomes were evaluated. In the CP group, compared with controls, the mean levels of lymphocytes and IL-10 significantly increased while the levels of IL-6, TNF-α, and IFN-γ decreased (p < 0.05). The length of in-hospital stay, and mortality rate did not significantly reduce in the CP group compared with controls (p > 0.05) while WHO severity scores remarkably improved (p = 0.01), despite the higher frequency of underlying diseases among the CP group (66.7%) vs. controls (33.3%). Although CP has a remarkable immunomodulatory and antiviral potential to improve the cytokine storm and disease severity in COVID-19 patients, it did not considerably affect the mortality rate.

Perspectives of Medieval Persian Medicine on Multiple Sclerosis.

INTRODUCTION: Traditional Persian Medicine (TPM) was the prevailing practice of medicine in the Eurasia region up through the 18th century, a practice of medicine stemming back to Hippocrates and to the 5000 year old civilization of the region. It is a school of medicine which touches on many a delicate points which may seem unimaginable within the realm of modern allopathic medicine. This practice of ancient medicine besides shedding light on various possible theoretical modern day disorders serves as a vast resource for therapeutics. In this paper, we present study of the manuscripts of this ancient medical practice in search of symptom presentations coinciding with presentation of multiple sclerosis (MS). MATERIAL & METHOD: This paper represents a comprehensive search through TPM texts and manuscripts with the intention to seek possible clues on MS from potentially valuable age-old resources. We predominantly focused our search on the works of five eminent physicians of Medieval Persia: Avicenna (980-1037 AD), Haly Abbas (949-982 AD), Rhazes (865-925 AD), Averroes (1126-1198 AD) and Jorjani (1042-1137 AD). RESULTS: In this paper, the authors attempt a theory and conclude with high probability that a conjunction of a series of signs, symptoms found in TPM texts under the terms khadar, isterkha and falej form the symptoms and the disease pattern of modern day MS. This theory draws upon existent similarities in terms of disease pathology, disease patterns and predisposing factors seen between MS and the related morbidities within Persian Medicine. CONCLUSION: We recommend further examinations of such potentially valuable long-standing resources, examining the diagnoses and treatments as set forth by Persian Medicine through international collaboration within the global scientific community.

Increased Serum Brain-derived Neurotrophic Factor in Multiple Sclerosis Patients on Interferon-ß and Its Impact on Functional Abilities.

OBJECTIVES: To investigate the potential role of disease-modifying therapies (DMTs) used to treat multiple sclerosis on inducing brain-derived neurotrophic factor (BDNF) production. METHODS: A total of 82 patients entered the study. Sixty (73%) patients were on DMTs (15 on Avonex, 13 on Rebif, 27 on Betaferon, 3 on Mitoxantrone, and 2 on IVIg), whereas 22 received no DMTs. The degree of neurological impairment was recorded using the expanded disability status scale (EDSS). Serum BDNF levels were assessed using the Sandwich ELISA method. We compared mean serum BDNF levels among patient groups based on whether or not they were on DMTs, and the specific agent used. Then, the relationship between BDNF levels and EDSS scores was assessed. The receiver operating characteristic (ROC) curve was used to calculate a cutoff value by which serum BDNF could predict the degree of disability. RESULTS: The study sample had a mean age of 34.6 years, mean EDSS score of 3.8, and mean BDNF level of 198.9 pg/mL. Patients on interferon-ß 1b therapy had significantly higher levels of BDNF compared with patients on Mitoxantrone or patients not on DMTs (237.6, 68.6, and 155.9, respectively; P=0.003). The degree of neurological impairment correlated negatively with BDNF levels (P<0.001). A cutoff value of 190 pg/mL was calculated for BDNF (ROC analysis, area under the curve: 0.729, P=0.002). At BDNF levels >190, the sensitivity for a milder degree of neurological impairment (EDSS<3) was 80%. CONCLUSIONS: This study showed a significant effect of interferon-ß 1b therapy on increasing BDNF production in multiple sclerosis.