Prognostic value of the novel P/FPE index to classify ARDS severity: A cohort study / Valor pronóstico del nuevo índice P/FPE para clasificar la severidad del SDRA: Estudio de cohorte

Objective To evaluate the impact of the novel P/FPE index to classify ARDS severity on mortality of patients with ARDS. Design A retrospective cohort study. Setting Twelve-bed medical and surgical intensive care unit from January 2018 to December 2020. Patients A total of 217 ARDS patients managed with invasive mechanical ventilation >48h. Interventions None. Variables ARDS severity on day 1 and day 3 was measured based on PaO2/FiO2 ratio and P/FPE index [PaO2/(FiO2×PEEP)]. Primary outcome was the hospital mortality. Results Hospital mortality rate was 59.9%. Relative to PaO2/FiO2 ratio, 31.8% of patients on day 1 and 77.0% on day 3 were reclassified into a different category of ARDS severity by P/FPE index. The level of PEEP was lower by P/FPE index-based ARDS severity classification than by using PaO2/FiO2 ratio. The performance for predicting mortality of P/FPE index was superior to PaO2/FiO2 ratio in term of AROC (day 1: 0.72 vs. 0.62; day 3: 0.87 vs. 0.68) and CORR (day 1: 0.370 vs. 0.213; day 3: 0.634 vs. 0.301). P/FPE index improved prediction of risk of death compared to PaO2/FiO2 ratio as showed by the qNRI (day 1: 72.0%, p<0.0001; day 3: 132.4%, p<0.0001) and IDI (day 1: 0.09, p<0.0001; day 3: 0.31, p<0.0001). Conclusions Assessment of ARDS severity based on P/FPE index seems better than PaO2/FiO2 ratio for predicting mortality. The value of P/FPE index for clinical decision-making requires confirmation by randomized controlled trials (AU)

Objetivo Evaluar el impacto del índice P/FPE para clasificar la severidad del SDRA y su relación con la mortalidad. Diseño Estudio de cohorte retrospectivo. Contexto Unidad de cuidados intensivos polivalentes de 12 camas desde enero de 2018 hasta diciembre de 2020. Pacientes Se estudió a 217 pacientes con SDRA con ventilación invasiva>48 horas. Intervenciones Ninguna. Variables La severidad del SDRA se evaluó el primer y el tercer día, según el índice PaO2/FiO2 y el índice P/FPE (PaO2/[FiO2×PEEP]). El desenlace primario evaluado fue la mortalidad hospitalaria. Resultados La mortalidad hospitalaria fue 59,9%. Con relación al índice PaO2/FiO2, el 31,8% de los pacientes el día 1 y el 77,0% el día 3 fue reclasificado en categorías diferentes de severidad del SDRA mediante el índice P/FPE. El nivel de PEEP fue más bajo con el uso del índice P/FPE que con el PaO2/FiO2. La predicción de la mortalidad fue superior con el índice P/FPE que con PaO2/FiO2, en términos de AROC (día 1: 0,72 vs. 0,62; día 3: 0,87 vs. 0,68) y CORR (día 1: 0,370 vs. 0,213; día 3: 0,634 vs. 0,301). El índice P/FPE mejoró la predicción del riesgo de muerte comparado con el PaO2/FiO2, como demuestra el qNRI (día 1: 72,0%, p<0,0001; día 3: 132,4%, p<0,0001) y el IDI (día 1: 0,09, p<0,0001; día 3: 0,31, p<0,0001). Conclusiones La evaluación de severidad del SDRA mediante el índice P/FPE parece ser mejor que la del índice PaO2/FiO2 para predecir la mortalidad. El valor del P/FPE para la toma de decisiones clínicas requiere confirmación mediante ensayos clínicos (AU)

[Predictive value of postoperative serum procalcitonin concentration for moderate to severe acute respiratory distress syndrome in patients undergoing cardiopulmonary bypass surgery].

OBJECTIVE: To explore the changes of serum procalcitonin (PCT) level in patients with moderate and severe acute respiratory distress syndrome (ARDS) after cardiac surgery under cardiopulmonary bypass (CPB), and try to find out the best cut-off of PCT to predict the progression to moderate and severe ARDS. METHODS: Medical records of patients undergoing cardiac surgery with CPB in Fujian Provincial Hospital from January 2017 to December 2019 were retrospectively analyzed. Adult patients who were admitted in intensive care unit (ICU) for more than 1 day and had PCT values on the first postoperative day were enrolled. Clinical data such as patient demographics, past history, diagnosis, and New York Heart Association (HYHA) classification, and the operation mode, procedure duration, CPB duration, aortic clamp duration, intraoperative fluid balance, calculation of 24 hours postoperative fluid balance and vasoactive-inotropic score (VIS); 24 hours postoperative C-reactive protein (CRP), N-terminal B-type natriuretic peptide precursor (NT-proBNP) and PCT levels were collected. Two clinicians independently made the diagnosis of ARDS according to the Berlin definition, and the diagnosis was established only in patients with a consistent diagnosis. The differences in each parameter were compared between patients with moderate to severe ARDS and those without or with mild ARDS. Analysis of the ability of PCT to predict moderate to severe ARDS was evaluated by receiver operator characteristic curve (ROC curve). Multivariate Logistic regression was conducted to determine the risk factors of the development of moderate to severe ARDS. RESULTS: 108 patients were finally enrolled, including 37 patients with mild ARDS (34.3%), 35 patients with moderate ARDS (32.4%), 2 patients with severe ARDS (1.9%), and 34 patients without ARDS. Compared with patients with no or mild ARDS, patients with moderate to severe ARDS were older (years old: 58.5±11.1 vs. 52.8±14.8, P < 0.05), with a higher proportion of combined hypertension [45.9% (17/37) vs. 25.4% (18/71), P < 0.05], longer operative time (minutes: 363.2±120.6 vs. 313.5±97.6, P < 0.05), and higher mortality (8.1% vs. 0, P < 0.05), but there were no differences in the VIS score, incidence of acute renal failure (ARF), CPB duration, aortic clamp duration, and intraoperative bleeding, transfusion volume, and fluid balance between the two groups. Serum PCT and NT-proBNP levels in patients with moderate to severe ARDS at postoperative day 1 were significantly higher than those in patients with no or mild ARDS [PCT (µg/L): 16.33 (6.96, 32.56) vs. 2.21 (0.80, 5.76), NT-proBNP (ng/L): 2 405.0 (1 543.0, 6 456.5) vs. 1 680.0 (1 388.0, 4 667.0), both P < 0.05]. ROC curve analysis showed that the area under the curve (AUC) for PCT to predict the occurrence of moderate to severe ARDS was 0.827 [95% confidence interval (95%CI) was 0.739-0.915, P < 0.05]. When PCT cut-off value was 7.165 µg/L, the sensitivity was 75.7% and the specificity was 84.5%, for differentiating patients who developed moderate to severe ARDS from who did not. Multivariate Logistic regression showed that age and the elevated PCT concentration were independent risk factors for the development of moderate to severe ARDS [age: odds ratio (OR) = 1.105, 95%CI was 1.037-1.177, P = 0.002; PCT: OR = 48.286, 95%CI was 10.282-226.753, P < 0.001]. CONCLUSIONS: Patients with moderate to severe ARDS undergoing CPB cardiac surgery have a higher serum concentration of PCT than patients with no or mild ARDS. Serum PCT level may be a promising biomarker to predict the development of moderate to severe ARDS, the cut-off value is 7.165 µg/L.

Boletim epidemiológico: perfil epidemiológico dos casos de síndrome respiratória aguda grave notificados no Centro Estadual de Reabilitação e Readaptação Dr. Henrique Santillo - CRER, janeiro a setembro/2023 / Epidemiological bulletin: epidemiological profile of cases of severe acute respiratory syndrome reported at the State Center for Rehabilitation and Readaptation Dr. Henrique Santillo - CRER, January to September/2023

Trata-se de um estudo epidemiológico descritivo retrospectivo, realizado a partir dos casos de síndrome respiratória aguda grave notificados em um hospital de referência em reabilitação do Estado de Goiás no período de janeiro a setembro de 2023. Os dados utilizados foram extraídos do SIVEP - Gripe (Sistema de Informação da Vigilância Epidemiológica da Gripe), que integra a base dos sistemas de informação do Departamento de Informática do Sistema Único de Saúde (DATASUS)

This is a retrospective descriptive epidemiological study, carried out based on cases of severe acute respiratory syndrome reported in a reference hospital for rehabilitation in the State of Goiás from January to September 2023. The data used were extracted from SIVEP - Gripe (Influenza Epidemiological Surveillance Information System), which forms part of the information systems base of the Information Technology Department of the Unified Health System (DATASUS)

Evolución del paciente diagnosticado de sindrome respiratorio agudo severo por coronavirus tipo 2 en función de la comorbilidad de la población adscrita al Centro de Salud Zona VI de Albacete / Risk factors for severity and mortality in adults testing positive for COVID-19 in the VI Health Area of Albacete

Objetivos: La bibliografía consultada, en su mayoría estudios descriptivos, establece asociación entre factores de riesgo para la salud, en su mayoría cardiovasculares, y la mala evolución de la COVID-19. Este estudio pretende mostrar dicha asociación entre la población perteneciente al área de salud zona vi de Albacete (España). Método: Estudio de cohortes de carácter retrospectivo. Mediante muestreo consecutivo se ha obtenido una muestra de 372 pacientes, mayores de 14 años, con diagnóstico confirmado de COVID-19. Los grupos se han dividido entre buena y mala evolución, entendiendo esta última como ingreso en UCI y/o muerte. Los datos obtenidos mediante la explotación de historias clínicas han sido analizados obteniendo frecuencias, Chi cuadrado con intervalo de confianza al 95% y ajustando por factores de confusión.ResultadosPor edad los pacientes con mala evolución tenían una media de 76 años, frente a los 48,7 años de los pacientes que evolucionaron favorablemente.Los pacientes con HTA presentaron peor evolución; siendo la Chi cuadrado <0,001 y la OR, para un intervalo de confianza del 95%, estuvo entre 3,97 y 21,42.En los paciente con DM también se relacionó la mala evolución de la enfermedad, siendo la Chi cuadrado <0,001 y la OR, para un intervalo de confianza del 95%, entre 2.766 y 12.690. Los pacientes que presentaban DM+HTA tenían un riesgo 5 veces superior de mala evolución respecto a los que solo presentaban una de las enfermedades.Nuestro estudio no pudo encontrar diferencias estadísticamente significativas entre el IMC, el sexo y los hábitos tóxicos (consumo de alcohol, tabaco y drogas) y la mala evolución de la COVID-19. Conclusiones: Los pacientes de mayor edad tuvieron un peor desenlace de la enfermedad, así como los hipertensos y diabéticos. No se encontró relación entre la evolución y la distribución por sexos. No se pudo establecer relación entre el IMC y hábitos tóxicos y la mala evolución.(AU)

Objectives: There are several retrospective studies that establish a relationship between some risk factors (cardiovascular risks mainly) and the development of COVID-19 and a severe outcome. Thus, our aim with this study is to find out the former relationship among the population within our basic health area. Method: Cohort study. The study sample consisted of 372 patients aged 14 or older who had tested positive for COVID-19 in our health centre by consecutive sampling. Data collected from medical records will be analysed using Frequencies, X2 with a Confidence interval of 95% and those carrying out the study will have prior experience/training in research and will be specifically trained for the aim of this research. Results: A worse outcome in patients aged 76 years old on average was found versus patients aged 48.7. Regarding high blood pressure patients, X2 was<.001 and OR between 3.975 and 21.425 with confidence interval of 95%, finding a worse outcome in these patients. With regard to Diabetes Mellitus (DM), X2 was<.001 and OR rated between 2.766 and 12.690 with a confidence interval of 95%, also resulting in a worse outcome in these patients. No significant differences regarding a worse outcome were found in Body Mass Index, gender, or toxic habits. Conclusions: Older patients had a worse outcome from COVID- 19, as well as patients with high blood pressure or DM. We found no differences regarding gender and neither could we find any differences regarding BMI.(AU)

COVID-19 associated symmetrical peripheral gangrene: A case series.

BACKGROUND AND AIMS: The novel coronavirus disease (COVID-19) caused by SARS-CoV-2 has turned the world topsy-turvy since its onset in 2019. The thromboinflammatory complications of this disease are common in critically ill patients and associated with poor prognosis. Symmetrical peripheral gangrene (SPG) is characterized by symmetrical distal gangrene in absence of any large vessel occlusion or vasculitis and it is usually associated with critical illness. Our aim was to report the clinical profile and outcome of patients diagnosed with SPG associated with COVID-19. To the best of our knowledge, no such similar cases have been reported till date. METHODS: In this case series, we have discussed the clinical presentation, laboratory parameters and outcome in a series of two patients of SPG associated with COVID-19 and also compared those findings. Due to paucity of data, we also reviewed the literature on this under-diagnosed and rarely reported condition and association. RESULTS: Two consecutive patients (both males, age range: 37-42 years, mean: 39.5 years) were admitted with the diagnosis of COVID-19 associated SPG. Both patients had clinical and laboratory evidence of disseminated intravascular coagulation (DIC). Leucopenia was noted in both patients. Despite vigorous therapy, both patients succumbed to their illness within a fortnight of admission. CONCLUSION: SPG in the background of COVID-19 portends a fatal outcome. Physicians should be aware of its grim prognosis.

Molecular detections of coronavirus: current and emerging methodologies.

INTRODUCTION: Seven coronavirus species have been identified that can infect humans. While human coronavirus infections had been historically associated with only mild respiratory symptoms similar to the common cold, three coronaviruses identified since 2003, Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV), Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and SARS-CoV-2, cause life-threatening severe respiratory syndromes. The coronavirus disease 2019 (COVID-19) caused by the highly transmissible SARS-CoV-2 has triggered a worldwide health emergency. Due to the lack of effective drugs and vaccination, rapid and reliable detection is of vital importance to control coronavirus epidemics/pandemics. AREA COVERED: A literature search was performed in Pubmed covering the detections and diagnostics of SARS, MERS and SARS-CoV-2. This review summarized the current knowledge of established and emerging methods for coronavirus detection. The characteristics of different diagnostic approaches were described, and the strengths and weaknesses of each method were analyzed and compared. In addition, future trends in the field of coronavirus detection were also discussed. EXPERT OPINION: Nucleic acid-based RT-PCR is the current golden-standard of coronavirus detection, while immunoassays provide history of coronavirus infection besides diagnostic information. Integrated high-throughput system holds the great potential and is the trend of future detection and diagnosis of virus infection.

Ethnological aspects of COVID-19

Abstract Within recent past, coronavirus has shaken the whole world. The world faced a new pandemic of novel coronavirus 2019 (SARS-CoV-2/ COVID-19).It has socioeconomically impacted world population a lot in terms of education, economy as well as physical and mental health. This novel coronavirus is notorious enough that put human health at a great risk. Currently, researchers all over the world aretrying hard to develop a new drug/vaccine for its treatment. In past decades, the world population has faced various viral infectious illness outbreaks. Influenza A, Ebola, Zika, SARS and MERS viruses had whacked public health and economy. Medical science technology achieved the landmark in developing coronavirus (SARS-CoV-2) vaccines that are approved currently for emergency use. Some of the recently approved vaccines are developed by Pfizer and Moderna, Johnson and Johnson, Gam-COVID-vac (Sputnik V), Bharat Biotech (covaxin) andOxford-AstraZeneca vaccines (covishield) (Badenet al., 2021). Here, a short review is drafted focusingon infection, immune system, pathogenesis, phylogenesis, mode of transmission and impact of coronavirus on health and economy and recent developments in treating COVID-19

A prospective evaluation of lung function at three and six months in patients with previous SARS-COV-2 pneumonia.

OBJECTIVE: This study investigated the consequences of Coronavirus Disease 2019 (COVID-19) pneumonia on lung function in the first 6 months after hospital discharge. METHODS: A prospective lung function assessment in SARS-CoV2 patients with COVID-19 pneumonia, hospitalized between March and April 2020, was conducted with spirometry measurements including lung volumes, mainly total lung capacity (TLC), lung diffusion capacity for carbon monoxide (DLCO) collected at 3 months after hospital discharge. Patients with restrictive ventilatory defect or impaired DLCO or both were re-evaluated at 6 months with global spirometry and chest HRCT scan. RESULTS: Among 40 consecutive patients, 19 (48%) had normal pulmonary functional tests (group A), and 21 (52%) showed residual lung function abnormalities at 3 months after hospital discharge (group B). In group B, 4 patients (19%) had only loss of lung volume as shown by TLC reduction (group 1), 13 patients (62%) had decreased both TLC and DLCO (group 2), and 4 patients (19%) had isolated reduction in DLCO (group 3). At 6-month follow-up in group 1, although all patients improved, only one normalized total lung capacity (TLC). In group 2, TLC and DLCO increased significantly (p < 0.01), but only 3 patients reached normal values. In group 3, DLCO improved for most patients, normalizing in 50% of them. At 6-months significant correlations between an internal-built chest HRCT scan severity score and TLC (r2 = 0.33; p < 0.01) and DLCO (r2 = 0.32; p < 0.01) were found. CONCLUSIONS: Nearly 50% of patients recovered in the post-critical phase. Most of those with abnormal pulmonary function tests at 3 months improved subsequently, but only another 29% (6 out of 21) reached normal values at 6 months. These results indicate that lung function spontaneous recovery is faster at first and occurs more slowly thereafter, leaving more than one third (15 out of 40) of patients with abnormal lung function tests at 6 months.

Clinical features of COVID-19 and SARS epidemics. A literature review.

SARS-CoV-2, responsible for the current pandemic, is a novel strain of the Coronaviridae family, which has infected humans as a result of the leap to a new species. It causes an atypical pneumonia similar to that caused by SARS-CoV in 2003. SARS-CoV-2 has currently infected more than 9,200,000 people and caused almost 480,000 deaths worldwide. Although SARS-CoV-2 and SARS-CoV have similar phylogenetic and pathogenetic characteristics, they show important differences in clinical manifestations. We have reviewed the recent literature comparing the characteristics of the two epidemics and highlight their peculiar aspects. An analysis of all signs and symptoms of 3,365 SARS patients and 23,280 COVID-19 patients as well as of the comorbidities has been carried out. A total of 17 and 75 studies regarding patients with SARS and COVID-19, respectively, were included in the analysis. The analysis revealed an overlap of some symptoms between the two infections. Unlike SARS patients, COVID-19 patients have developed respiratory, neurological and gastrointestinal symptoms, and, in a limited number of subjects, symptoms involving organs such as skin and subcutaneous tissue, kidneys, cardiovascular system, liver and eyes. This analysis was conducted in order to direct towards an early identification of the infection, a suitable diagnostic procedure and the adoption of appropriate containment measures.

Nota Informativa N. 4/2021 - ASREA - 18776 - Protocolo Assistencial: gestantes e puérperas com síndrome gripal / Informative Note N. 4/2021 - ASREA - 18776 - Assistance Protocol: pregnant and postpartum women with flu syndrome

O Ministério da Saúde orienta que gestantes e puérperas até o 14º dia de pós-parto devem ser consideradas grupo de risco para Covid-19. Identificar a doença e reconhecer o agravamento de sintoma, de acordo com os protocolos institucionais ou nacionais, possibilita o início oportuno de tratamento de suporte, admissão em leito de enfermaria hospitalar ou unidade de terapia intensiva

The Ministry of Health guides that pregnant and postpartum women up to the 14th postpartum day should be considered a risk group for Covid-19. Identifying the disease and recognizing the worsening of symptoms, according to institutional or national protocols, allows the beginning timely supportive care, admission to a hospital ward or intensive care unit

Dynamic Antibody Response: a Biomarker for COVID-19.

BACKGROUND: Novel coronavirus disease 2019 (COVID-19) is the cause of the third pneumonia-like outbreak of coronaviruses in humans during the 21st century. The status of the host immune system is a critical factor that affects the severity and outcomes of COVID-19. In particular, antibody responses are an indicator of the anti-viral defense; so, a delayed or inappropriate induction of these responses would correlate with a defect in the viral clearance. METHODS: This is a rapid synthesis of literature investigating antibody responses in patients with the severe acute respiratory syndrome (SARS) and COVID-19. RESULTS: Lessons learned from severe acute respiratory syndrome (SARS), along with the direct evidence of antibody responses in COVID-19, pose the potentials of dynamic antibody responses for screening and prognostic purposes in COVID-19. Also, neutralizing antibodies extracted from recovered patients and monoclonal antibodies targeting cytokines offer therapeutic support for COVID-19. CONCLUSIONS: Altogether, the dynamics of antibody responses help to determine the effectiveness of treatments for COVID-19. Of note, it might be helpful for the evaluation of the efficacy of immunotherapy and vaccination - the dreams for the future of COVID-19. Further studies are necessary to investigate the possibility and efficacy of antibody extraction from animal subjects. Finally, numerous factors affect antibody response such as race, nutrition status, and virus mutations in viral infections, which need to be considered in the context of COVID-19.

The next-generation coronavirus diagnostic techniques with particular emphasis on the SARS-CoV-2.

The potential zoonotic coronaviruses (SARS-CoV, MERS-CoV, and SARS-CoV-2) are of global health concerns. Early diagnosis is the milestone in their mitigation, control, and eradication. Many diagnostic techniques are showing great success and have many advantages, such as the rapid turnover of the results, high accuracy, and high specificity and sensitivity. However, some of these techniques have several pitfalls if samples were not collected, processed, and transported in the standard ways and if these techniques were not practiced with extreme caution and precision. This may lead to false-negative/positive results. This may affect the downstream management of the affected cases. These techniques require regular fine-tuning, upgrading, and optimization. The continuous evolution of new strains and viruses belong to the coronaviruses is hampering the success of many classical techniques. There are urgent needs for next generations of coronaviruses diagnostic assays that overcome these pitfalls. This new generation of diagnostic tests should be able to do simultaneous, multiplex, and high-throughput detection of various coronavirus in one reaction. Furthermore, the development of novel assays and techniques that enable the in situ detection of the virus on the environmental samples, especially air, water, and surfaces, should be given considerable attention in the future. These approaches will have a substantial positive impact on the mitigation and eradication of coronaviruses, including the current SARS-CoV-2 pandemic.

Coronavirus Occurrence in the Household Influenza Vaccine Evaluation (HIVE) Cohort of Michigan Households: Reinfection Frequency and Serologic Responses to Seasonal and Severe Acute Respiratory Syndrome Coronaviruses.

BACKGROUND: We investigated frequency of reinfection with seasonal human coronaviruses (HCoVs) and serum antibody response following infection over 8 years in the Household Influenza Vaccine Evaluation (HIVE) cohort. METHODS: Households were followed annually for identification of acute respiratory illness with reverse-transcription polymerase chain reaction-confirmed HCoV infection. Serum collected before and at 2 time points postinfection were tested using a multiplex binding assay to quantify antibody to seasonal, severe acute respiratory syndrome coronavirus (SARS-CoV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike proteins and SARS-CoV-2 spike subdomains and N protein. RESULTS: Of 3418 participants, 40% were followed for ≥3 years. A total of 1004 HCoV infections were documented; 303 (30%) were reinfections of any HCoV type. The number of HCoV infections ranged from 1 to 13 per individual. The mean time to reinfection with the same type was estimated at 983 days for 229E, 578 days for HKU1, 615 days for OC43, and 711 days for NL63. Binding antibody levels to seasonal HCoVs were high, with little increase postinfection, and were maintained over time. Homologous, preinfection antibody levels did not significantly correlate with odds of infection, and there was little cross-response to SARS-CoV-2 proteins. CONCLUSIONS: Reinfection with seasonal HCoVs is frequent. Binding anti-spike protein antibodies do not correlate with protection from seasonal HCoV infection.

Ministério da Saúde orienta estados sobre medidas preventivas em função de nova variante do SARS-CoV-2

O Ministério da Saúde emitiu nesta terça-feira (2) Nota Técnica para os Estados e Distrito Federal sobre a nova variante do SARS-CoV-2 identificada no Brasil. O documento traz informações sobre as características da nova variante do Amazonas (VOC P.1) e orientações e recomendações de medidas que devem ser adotadas e intensificadas pelas secretarias de saúde estaduais, a fim de monitorar e evitar a propagação da nova variante.

Detection of SARS-CoV-2 using real-time polymerase chain reaction in different clinical specimens: A critical review.

Coronavirus disease 2019 (COVID-19) is a disease caused by a new strain of coronavirus named as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Globally, since the outbreak, more than seven million confirmed cases of COVID-19 have been reported. The rapid spread and increase in the number of new cases is due to person-to-person transmission. To further control its transmission, early laboratory diagnosis of both asymptomatic and symptomatic patients is crucial. Presently, the COVID-19 diagnosis of infected individuals is dependent on computed tomography scanning and real-time polymerase chain reaction (PCR). The latter is considered more sensitive and efficient for early diagnosis. In this review, general comparisons are made (cases, fatality rate, incubation period, clinical features, and reservoirs) and diagnostic laboratory procedures (specimens, extraction methods, and positive rates by real-time PCR) are compared between SARS, Middle East Respiratory Syndrome, and SARS-2. In total, 8982 SARS-2 suspected patients specimen data were retrieved, in which 40.9% (n = 3678) were detected as positive by real-time PCR. The specimen-wise high detection rate was observed from bronchoalveolar lavage, followed by saliva, nasal swabs, and sputum. As the COVID-19 cases are persistently increasing, the selection of appropriate specimens and laboratory assay would help in rapid and timely diagnosis.

Serological assays and host antibody detection in coronavirus-related disease diagnosis.

Coronaviruses (CoV) are a family of viral pathogens that infect both birds and mammals, including humans. Seven human coronaviruses (HCoV) have been recognized so far. HCoV-229E, -OC43, -NL63, and -HKU1 account for one-third of common colds with mild symptoms. The other three members are severe acute respiratory syndrome (SARS)-CoV, Middle East respiratory syndrome (MERS)-CoV, and SARS-CoV-2. These viruses are responsible for SARS, MERS, and CoV disease 2019 (COVID-19), respectively. A variety of diagnostic techniques, including chest X-rays, computer tomography (CT) scans, analysis of viral nucleic acids, proteins, or whole virions, and host antibody detection using serological assays have been developed for the detection of these viruses. In this review, we discuss conventional serological tests, such as enzyme-linked immunosorbent assay (ELISA), western blot (WB), immunofluorescence assay (IFA), lateral flow immunoassay (LFIA), and chemiluminescence immunoassay (CLIA), as well as biosensor-based assays that have been developed for diagnosing HCoV-associated diseases since 2003, with an in-depth focus on COVID-19.

A fluorescence-based high throughput-screening assay for the SARS-CoV RNA synthesis complex.

The Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) emergence in 2003 introduced the first serious human coronavirus pathogen to an unprepared world. To control emerging viruses, existing successful anti(retro)viral therapies can inspire antiviral strategies, as conserved viral enzymes (eg., viral proteases and RNA-dependent RNA polymerases) represent targets of choice. Since 2003, much effort has been expended in the characterization of the SARS-CoV replication/transcription machinery. Until recently, a pure and highly active preparation of SARS-CoV recombinant RNA synthesis machinery was not available, impeding target-based high throughput screening of drug candidates against this viral family. The current Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) pandemic revealed a new pathogen whose RNA synthesis machinery is highly (>96 % aa identity) homologous to SARS-CoV. This phylogenetic relatedness highlights the potential use of conserved replication enzymes to discover inhibitors against this significant pathogen, which in turn, contributes to scientific preparedness against emerging viruses. Here, we report the use of a purified and highly active SARS-CoV replication/transcription complex (RTC) to set-up a high-throughput screening of Coronavirus RNA synthesis inhibitors. The screening of a small (1520 compounds) chemical library of FDA-approved drugs demonstrates the robustness of our assay and will allow to speed-up drug discovery against the SARS-CoV-2.

Current methods for diagnosis of human coronaviruses: pros and cons.

The current global fight against coronavirus disease (COVID-19) to flatten the transmission curve is put forth by the World Health Organization (WHO) as there is no immediate diagnosis or cure for COVID-19 so far. In order to stop the spread, researchers worldwide are working around the clock aiming to develop reliable tools for early diagnosis of severe acute respiratory syndrome (SARS-CoV-2) understanding the infection path and mechanisms. Currently, nucleic acid-based molecular diagnosis (real-time reverse transcription polymerase chain reaction (RT-PCR) test) is considered the gold standard for early diagnosis of SARS-CoV-2. Antibody-based serology detection is ineffective for the purpose of early diagnosis, but a potential tool for serosurveys, providing people with immune certificates for clearance from COVID-19 infection. Meanwhile, there are various blooming methods developed these days. In this review, we summarise different types of coronavirus discovered which can be transmitted between human beings. Methods used for diagnosis of the discovered human coronavirus (SARS, MERS, COVID-19) including nucleic acid detection, gene sequencing, antibody detection, antigen detection, and clinical diagnosis are presented. Their merits, demerits and prospects are discussed which can help the researchers to develop new generation of advanced diagnostic tools for accurate and effective control of human coronavirus transmission in the communities and hospitals.