Therapeutic Options and Critical Care Strategies in COVID-19 Patients; Where Do We Stand in This Battle?

A pandemic of COVID-19 made an appearance in Wuhan, China, in late December 2019 and rapidly became a serious concern worldwide, with killing more than 238000 people until 3rd May 2020. Given the fact that a vaccine against the virus probably won’t be available anytime in the near future, the therapeutic strategies have become more prominent. Many supposedly effective drugs are under evaluation which may hinder the replication of SARS-CoV-2, and subsequently the infection. Lately on 1th may 2020, FDA authorized the use of experimental drug, Remdesivir for "emergency purpose" in COVID-19 cases. Chloroquine and hydroxychloroquine, among the very first under-trial drugs, have been revealed to have promising impacts in treatment of SARS-CoV2. Broad-spectrum antivirals as well as HIV protease-inhibitors are still subject to assessment. Particularly angiotensin-converting enzyme 2 (ACE2) inhibitors are increasingly taken into consideration because of ACE2 being recognized as a host-cell receptor for COVID-19. Immune-Enhancement therapy by Interferons and Intravenous immunoglobulin (IVIG) has been shown to be effective in some cases. Moreover, Convalescent Plasma Therapy and auxiliary blood purification were considered as the treatment of SARS-CoV2 infection. Among the critically ill patients, Oxygen-therapy, timely usage of inflammatory inhibitors, and controlling viral shedding by antivirals may reduce the mortality and morbidity of COVID-19

Three doses of a recombinant conjugated SARS-CoV-2 vaccine early after allogeneic hematopoietic stem cell transplantation: predicting indicators of a high serologic response—a prospective, single-arm study

BackgroundAllogeneic hematopoietic stem cell transplant (allo-HSCT) recipients must be vaccinated against SARS-CoV-2 as quickly as possible after transplantation. The difficulty in obtaining recommended SARS-CoV-2 vaccines for allo-HSCT recipients motivated us to utilize an accessible and affordable SARS-CoV-2 vaccine with a recombinant receptor-binding domain (RBD)–tetanus toxoid (TT)-conjugated platform shortly after allo-HSCT in the developing country of Iran.MethodsThis prospective, single-arm study aimed to investigate immunogenicity and its predictors following a three-dose SARS-CoV-2 RBD–TT-conjugated vaccine regimen administered at 4-week (± 1-week) intervals in patients within 3–12 months post allo-HSCT. An immune status ratio (ISR) was measured at baseline and 4 weeks (± 1 week) after each vaccine dose using a semiquantitative immunoassay. Using the median ISR as a cut-off point for immune response intensity, we performed a logistic regression analysis to determine the predictive impact of several baseline factors on the intensity of the serologic response following the third vaccination dose.ResultsThirty-six allo-HSCT recipients, with a mean age of 42.42 years and a median time of 133 days between hematopoietic stem cell transplant (allo-HSCT) and the start of vaccination, were analyzed. Our findings, using the generalized estimating equation (GEE) model, indicated that, compared with the baseline ISR of 1.55 [95% confidence interval (CI) 0.94 to 2.17], the ISR increased significantly during the three-dose SARS-CoV-2 vaccination regimen. The ISR reached 2.32 (95% CI 1.84 to 2.79; p = 0.010) after the second dose and 3.87 (95% CI 3.25 to 4.48; p = 0.001) after the third dose of vaccine, reflecting 69.44% and 91.66% seropositivity, respectively. In a multivariate logistic regression analysis, the female sex of the donor [odds ratio (OR) 8.67; p = 0.028] and a higher level donor ISR at allo-HSCT (OR 3.56; p = 0.050) were the two positive predictors of strong immune response following the third vaccine dose. No serious adverse events (i.e., grades 3 and 4) were observed following the vaccination regimen.ConclusionsWe concluded that early vaccination of allo-HSCT recipients with a three-dose RBD–TT-conjugated SARS-CoV-2 vaccine is safe and could improve the early post-allo-HSCT immune response. We further believe that the pre-allo-HSCT SARS-CoV-2 immunization of donors may enhance post-allo-HSCT seroconversion in allo-HSCT recipients who receive the entire course of the SARS-CoV-2 vaccine during the first year after allo-HSCT

Novelty–variety as a candidate basic psychological need: New evidence across three studies

This paper investigates the plausibility of novelty–variety as a potential basic psychological need in a series of three studies. Using criteria proposed by Baumeister and Leary (Psychol Bull 117:497–529, 1995) and Ryan and Deci (in Self-determination theory: basic psychological needs in motivation, development, and wellness. Guilford Publishing, New York, 2017) to establish a motive as a basic human need, we focus on those criteria where evidence is lacking. Specifically, we examine whether novelty–variety is distinct from other needs in Basic Psychological Need Theory (BPNT) proposed by Self-Determination Theory (SDT), whether its absence results in adverse effects and its satisfaction uniquely predicts well-being outcomes, and whether the effects are different across age and personality. In Study 1, participants (N = 202) rated novelty–variety and needs from BPNT (competence, autonomy, relatedness) in three domains to assess its independence from these needs and the extent to which novelty–variety uniquely relates to domain-specific well-being. In Study 2 (N = 414), the fulfillment of novelty–variety and two BPNT needs (autonomy and relatedness) was experimentally manipulated in work-related vignettes, further showing that unsatisfied novelty–variety is related to lower well-being. Finally, the third study (N = 599) accounts for some of the limitations in Study 2 and examines the criteria of universality. Based on the examined criteria, all three studies provide support for further considering novelty–variety as a potential basic psychological need

Spatial Analysis of Colorectal Cancer Incidence in Hamadan Province, Iran: a Retrospective Cross-Sectional Study

Abstract Colorectal Cancer (CRC) is ranked the third most common cancer in women and the fourth in men in Iran. Many factors contribute to CRC occurrence, and most of them are interrelated. The present study aimed to explore the spatial pattern of CRC incidence in Hamadan province, Iran. We collected and analyzed data on patients’ location, gender, age, and date of diagnosis recorded in the CRC registry between 2007 and 2014 in Hamadan province. The Anselin Local Moran’s I statistic was conducted to identify clusters and outliers of CRC distribution. There were 805 recorded CRC cases in Hamadan province during 2007–2014, with an incidence of 45.89 patients per 100,000 people. Three significant clusters of both high and low incidence rate were found in the study area. This research demonstrated significant geographical disparities in CRC incidence in Hamadan province. The spatial analysis of CRC incidence pattern generates new hypothesis on effect of location in disease clusters. These findings may shine light on underlying risk factors in areas where the CRC risk is greater and how contextual factors may play a role in CRC geographic disparity. Keywords Colorectal cancer . Geographical information system . Iran . Spatial analysis . Cluster analysisWe would like to thank Hamadan University of Medical Sciences because of funding this project

Evaluation of Safety and Immunogenicity of a Recombinant Receptor-Binding Domain (RBD)-Tetanus Toxoid (TT) Conjugated SARS-CoV-2 Vaccine (PastoCovac) in Recipients of Autologous Hematopoietic Stem Cell Transplantation Compared to the Healthy Controls; A Prospective, Open-Label Clinical Trial

Background: The urgent need for prompt SARS-CoV-2 immunization of hematopoietic stem cell transplant (HSCT) recipients in an endemic area raises many challenges regarding selecting a vaccine platform appropriate for HSCT recipients being economical for widespread use in developing countries. Methods: The trial is a prospective, single-group, open-label study to investigate the safety and serologic response of two doses of the recombinant receptor-binding domain (RBD)-Tetanus Toxoid (TT) conjugated SARS-CoV-2 vaccine (PastoCovac) early after autologous (auto) HSCT. For this reason, a total of 38 patients who completed the two-dose SARS-CoV-2 RBD-based vaccine between three to nine months after auto-HSCT and had an available anti-spike serologic test at three predefined time points of baseline and after the first and second doses and 50 healthy control individuals were included in the analysis. The primary outcome was defined as an increase in IgG Immune status ratio (ISR) to the cut-off value for the positive result (≥1.1) in the semiquantitative test. Findings: The median time between auto-HSCT and vaccination was 127 days. No participant reported any significant adverse effects (Grade 3). Pain at the injection site was the most common adverse event. The ISR increased significantly (p p = 0.02] and history of obtaining COVID-19 infection before transplantation [OR: 6.24 (95% CI: 1.17–33.15); p = 0.03] remained the predictors of the stronger immune response following two doses of the RBD-TT conjugated vaccine. Moreover, we found that the immunogenicity of the COVID-19 vaccine shortly after transplantation could be influenced by pre-transplant COVID-19 vaccination. Interpretation: The RBD-TT conjugated SARS-CoV-2 vaccine was safe, highly immunogenic, and affordable early after autologous transplants. Funding: This work was mainly financed by the Hematology-Oncology-Stem Cell Transplantation Research Center (HORCSCT) of Tehran University and the Pasteur Institute of Iran

Sulfonated NbS2-based proton-exchange membranes for vanadium redox flow batteries

In this work, novel proton-exchange membranes (PEMs) based on sulfonated poly(ether ether ketone) (SPEEK) and two-dimensional (2D) sulfonated niobium disulphide (S-NbS2) nanoflakes are synthesized by a solution-casting method and used in vanadium redox flow batteries (VRFBs). The NbS2 nanoflakes are produced by liquid-phase exfoliation of their bulk counterpart and chemically functionalized with terminal sulfonate groups to improve dimensional and chemical stabilities, proton conductivity (sigma) and fuel barrier properties of the as-produced membranes. The addition of S-NbS2 nanoflakes to SPEEK decreases the vanadium ion permeability from 5.42 x 10(-7) to 2.34 x 10(-7) cm(2) min(-1). Meanwhile, it increases the membrane sigma and selectivity up to 94.35 mS cm(-2) and 40.32 x 10(4) S min cm(-3), respectively. The cell assembled with the optimized membrane incorporating 2.5 wt% of S-NbS2 nanoflakes (SPEEK:2.5% S-NbS2) exhibits high efficiency metrics, i.e., coulombic efficiency between 98.7 and 99.0%, voltage efficiency between 90.2 and 73.2% and energy efficiency between 89.3 and 72.8% within the current density range of 100-300 mA cm(-2), delivering a maximum power density of 0.83 W cm(-2) at a current density of 870 mA cm(-2). The SPEEK:2.5% S-NbS2 membrane-based VRFBs show a stable behavior over 200 cycles at 200 mA cm(-2). This study opens up an effective avenue for the production of advanced SPEEK-based membranes for VRFBs