Cutaneous Manifestations in Patients with SARS- CoV-2 Infections

While SARS-CoV-2 is known to cause pneumonia and acute respiratory distress syndrome (ARDS), many extrapulmonary manifesta- tions of COVID-19 have also been observed. Cutaneous manifestations including erythematous rash, urticaria, and chickenpox-like vesicles have been described in patients with SARS-CoV-2. Six patients, two men and four women, in the age group of 50 to 60 years old, hospitalized with SARS-CoV-2 infection confirmed with real-time polymerase chain reac- tion (real-time PCR) presented cutaneous manifestations. The rash was confluent, spotty, centrifugal, and non-itchy on the head and torso. It was not hemorrhagic, and no crust or blisters were observed. The results of laboratory tests were normal, and the rash disappeared on its own. Sev- eral cases of cutaneous manifestations have been reported in patients with SARS-CoV-2 infection. Further studies are needed in order to assess the skin lesions and determine their association with COVID-19

Cutaneous Manifestations in Patients with SARS- CoV-2 Infections

While SARS-CoV-2 is known to cause pneumonia and acute respiratory distress syndrome (ARDS), many extrapulmonary manifesta- tions of COVID-19 have also been observed. Cutaneous manifestations including erythematous rash, urticaria, and chickenpox-like vesicles have been described in patients with SARS-CoV-2. Six patients, two men and four women, in the age group of 50 to 60 years old, hospitalized with SARS-CoV-2 infection confirmed with real-time polymerase chain reac- tion (real-time PCR) presented cutaneous manifestations. The rash was confluent, spotty, centrifugal, and non-itchy on the head and torso. It was not hemorrhagic, and no crust or blisters were observed. The results of laboratory tests were normal, and the rash disappeared on its own. Sev- eral cases of cutaneous manifestations have been reported in patients with SARS-CoV-2 infection. Further studies are needed in order to assess the skin lesions and determine their association with COVID-19

SARSCOV-2 PSYCHOSOMATIC EFFECTS AND FEAR OF STIGMA ON THE DISCHARGE DAY OF INFECTED INDIVIDUALS: SAPFO STUDY

Background: Although research has been mainly focused on effective treatment for SARS-COV-2 infection, psychosocial aspects of the infection it is vital to be taken into consideration. The aim of the present study is to evaluate the psychosomatic effects and the fear of stigma which patients may face after the end of treatment and discharge from hospital. Subjects and methods:This was a non-intervention perspective study conducted in the Department of Infectious Diseases of University General Hospital of Alexandroupolis (Greece). Patients on the discharge day completed questionnaires in which 5 topics were evaluated: pain/discomfort, anxiety/distress, fear/worries, stigma and tolerance of treatment. The questionnaires were derived from similar Quality of Life Tools. The total score of each patient was normalized as percentage. Results: Females and younger than 40 years old had more worries and fears on discharge day. Significant factors were days of hospitalization, days of fever and need of oxygen therapy. Patients who hospitalized more than 10 days, particularly in isolation negative pressure rooms, with persistent fever more than 7 days and need of oxygen therapy had more anxiety, worries for their clinical condition and fear of stigma. The majority of patients (80%) were expecting to face moderate to severe problems with family members, friends and colleagues underlying the dimensions of stigma. Conclusions: It is crucial to evaluate the psychosocial aspects of this infection and limit the stigma which patients may face returning to their daily routine. Further studies are needed with larger patient series and with the usage of psychometric instruments

Development of standardized method for the determination of the degradation of nitric oxide (NO) in the air by photocatalytic materials: Inter-laboratory validation tests

International audienceThe need of a uniform experimental procedure for assessing the performance of photocatalytic inorganic materials contained in building materials led the European Committee for Standardization (CEN/TC386/WG2) to elaborate a Technical Specification (TS).Taking into consideration the importance of the effects which will be of possible variations in the implementation of the reference method, parallel photocatalytic tests according to the TS were performed in the current study. 6 European labs were participated in an inter-laboratory exercise where the experiments had to be done in a special design CEN reactor using LED system. The experimental procedure and conditions were taken from the draft TS and were referred to the average irradiance, inlet NO & NO 2 concentration, T o C and RH inside the reactor, flow and reactor net volume. Identical photocatalytic samples were provided to all participants. The results obtained from the 6 labs showed a variation between 18% and 31% on the photocatalytic NO conversion while the mean value was 26%. The corresponding photocatalytic rate was ranged between 2600 μg/m 2 h and 4100 μg/m 2 h presenting a mean value of 3400 μg/m 2 h. The homogeneity of the lamp and the homogeneity of the deposition of TiO 2 are the main factors impacting the results

Effect of the Novel Influenza A (H1N1) Virus in the Human Immune System

BACKGROUND: The pandemic by the novel H1N1 virus has created the need to study any probable effects of that infection in the immune system of the host. METHODOLOGY/PRINCIPAL FINDINGS: Blood was sampled within the first two days of the presentation of signs of infection from 10 healthy volunteers; from 18 cases of flu-like syndrome; and from 31 cases of infection by H1N1 confirmed by reverse RT-PCR. Absolute counts of subtypes of monocytes and of lymphocytes were determined after staining with monoclonal antibodies and analysis by flow cytometry. Peripheral blood mononuclear cells (PBMCs) were isolated from patients and stimulated with various bacterial stimuli. Concentrations of tumour necrosis factor-alpha, interleukin (IL)-1beta, IL-6, IL-18, interferon (FN)-alpha and of IFN-gamma were estimated in supernatants by an enzyme immunoassay. Infection by H1N1 was accompanied by an increase of monocytes. PBMCs of patients evoked strong cytokine production after stimulation with most of bacterial stimuli. Defective cytokine responses were shown in response to stimulation with phytohemagglutin and with heat-killed Streptococcus pneumoniae. Adaptive immune responses of H1N1-infected patients were characterized by decreases of CD4-lymphocytes and of B-lymphocytes and by increase of T-regulatory lymphocytes (Tregs). CONCLUSIONS/SIGNIFICANCE: Infection by the H1N1 virus is accompanied by a characteristic impairment of the innate immune responses characterized by defective cytokine responses to S.pneumoniae. Alterations of the adaptive immune responses are predominated by increase of Tregs. These findings signify a predisposition for pneumococcal infections after infection by H1N1 influenza

In vitro elution of antimicrobial agents by a synthetic crystallic semihydrate form of calcium sulphate ( stimulan)

Background: Chronic osteomyelitis presents significant therapeutic difficulties. Long term antimicrobial treatment is hampered by tissue penetration issues and the development of adverse events. On the other hand surgical intervention is usually necessary. Treatment of osteomyelitis with local delivery systems has become common practice whereas several biodegradable substances have been employed as the vehicle of delivery. Methods: We used Stimulan™, (in a powder and mixing solution form) a synthetic biocompatible bone graft material that is completely resorbed to be replaced by new bone. Characteristics of the aforementioned material are 100% purity, osteoconductive-osteoinductive action and ability of biodegradation. Moxifloxacin or fusidic acid and CaSO4 were admixed at a ratio of 95:5 up to a total weight of 3gr, at room temperature in five sterile vials. Mueller-Hinton broth (1ml) was added over the free surface of the mixture and replaced every 24h. The samples were incubated in 37? C. In vitro elution was estimated daily using a High Performance Liquid Chromatography (HPLC) system and a microbiology agar diffusion assay. Results: Elution of moxifloxacin lasted for 31 days. Eluted concentrations reached their peak on Day 13 (mean level 745μg/ml) whereas the lowest concentration was detected on Day 30 (mean level 367 μg/ml) according to the HPLC estimation. Elution of fusidic acid lasted for 14 days. Eluted concentrations reached their peak on Day 6 (mean value 249.5 μg/ml) whereas the lowest eluted concentration was detected on Day 13 (mean value 10.9μg/ml). Conclusions: Elution of moxifloxacin and fusidic acid is high indicating that Stimulan™ may be used as a local antibiotic delivery system. Further studies in experimental osteomyelitis should be performed to further evaluate this effect in vivo.Εισαγωγή: Η χρόνια οστεομυελίτις έχει θεραπευτικές δυσκολίες. Απαιτεί τόσο χειρουργική, όσο και παθολογική αντιμετώπιση, με μακροχρόνια χορήγηση αντιμικροβιακών ουσιών, η οποία με τη σειρά της μειονεκτεί από την άποψη της φαρμακοκινητικής στα οστά και από τις ανεπιθύμητες ενέργειες που εμφανίζονται συχνά. Η συνδυασμένη αντιμετώπιση της οστεομυελίτιδας με τοπικά συστήματα απελευθέρωσης αντιβιοτικών χρησιμοποιείται ευρέως, είτε με αποδομήσιμα ή με μη αποδομήσιμα υλικά. Μεθοδολογία: Χρησιμοποιήσαμε το Stimulan™ (σε μορφή σκόνης), ένα συνθετικό βιοαπορροφήσιμο υλικό, το οποίο απορροφείται πλήρως και αντικαθίσταται από νέο οστό. Χαρακτηρίζεται από 100% καθαρότητα, οστεοβλαστική δραστικότητα και ικανότητα πλήρους αποδόμησης. Επιλέχθηκαν η μοξιφλοξασίνη και το φουσιδικό οξύ, δύο αντιμικροβιακές ουσίες με εξαιρετική αντισταφυλοκοκκική δράση. Η μοξιφλοξασίνη ή το φουσιδικό οξύ και το CaSO4 αναμείχθηκαν σε αναλογία 5:95 με συνολικό βάρος 3 γραμμαρίων, σε θερμοκρασία δωματίου σε 5 αποστειρωμένους σωληνίσκους. Στην ελεύθερη επιφάνεια του μίγματος προσετέθη 1ml ζωμού Muller-Hinton, ο οποίος και αντικαθίστατο κάθε 24 ώρες. Τα δείγματα επωάζονταν στους 37? C. Οι συγκεντρώσεις του αντιμικροβιακού που αποδεσμεύονταν υπολογίστηκαν με τη μέθοδο της Υγράς Χρωματογραφίας Υψηλής Απόδοσης (HPLC) και με την μικροβιολογική μέθοδο (μέθοδο διάχυσης σε άγαρ), με πρότυπους μικροοργανισμούς τον Bacillus subtilis ATCC 6633 και το Corynebacterium 404 CIP 5216 για την μοξιφλοξασίνη και το φουσιδικό οξύ αντίστοιχα και την συνδρομή προγράμματος ηλεκτρονικού υπολογιστή. Αποτελέσματα: Η αποδέσμευση της μοξιφλοξασίνης διήρκεσε 31 ημέρες. Σύμφωνα με τις μετρήσεις της HPLC μεθόδου τα μέγιστα επίπεδα επιτεύχθηκαν την 13η ημέρα (μέση τιμή 745 μg/ml) ενώ τα ελάχιστα σημειώθηκαν την 30η ημέρα (μέση τιμή 367μg/ml). Η απελευθέρωση του φουσιδικού οξέος κράτησε 14 ημέρες, με τα μέγιστα επίπεδα να καταγράφονται την 6η ημέρα (μέση τιμή 249,5 μg/ml) και τα ελάχιστα την 13η ημέρα (μέση τιμή 10,9μg/ml). Εξίσου ικανοποιητικές ήταν και οι μετρήσεις με την μικροβιολογική μέθοδο εις αμφότερες τις αντιμικροβιακές ουσίες. Συμπεράσματα: Η απελευθέρωση τόσο της μοξιφλοξασίνης όσο και του φουσιδικού οξέος είναι υψηλές και καταδεικνύει την δυνατότητα του Stimulan να χρησιμοποιηθεί ως σύστημα απελευθέρωσης αντιμικροβιακών ουσιών. Περαιτέρω μελέτες σε πειραματικά μοντέλα οστεομυελίτιδας είναι απαραίτητα για την τεκμηρίωση αυτών των δεδομένων in vivo

The Antiviral Effect of Nirmatrelvir/Ritonavir during COVID-19 Pandemic Real-World Data

Introduction: Vaccination against SARS-CoV-2 and the prevalence of Omicron variants have reduced the risk of the severe clinical progress of COVID-19. However, the risk of breakthrough infections has increased, and early administration of an effective antiviral treatment is significant in order to prevent the severe progression of COVID-19 in vulnerable patients with comorbidities. Patients and methods: Adults with confirmed SARS-CoV-2 infection were included in a matched-pair retrospective study based on age, gender, comorbidities and vaccination status. They were divided into two groups: group A (n = 200) consisted of outpatients at increased risk of severe clinical progress who were treated with nirmatrelvir/ritonavir and group B (n = 200) consisted of non-hospitalized patients who did not receive antiviral treatment. Demographic data, clinical outcome (death, intubation), days of hospitalization, time for recovery, adverse events and treatment compliance were reported. Results: The median age (75.24 ± 13.12 years in the study group and 76.91 ± 14.02 years in the comparison group) and the proportion of males (59% vs. 60.5%, respectively) were similar between the two groups. A total of 6.5% of patients in group A and 10.5% in group B were unvaccinated against SARS-CoV-2. Three patients from group A (1.5%) and one hundred eleven (55.5%) from group B required hospitalization. The duration of hospitalization (3 days vs. 10 days in group B, p p < 0.001) was shorter in the study group. A rebound of SARS-CoV-2 infection within 8–12 days after diagnosis was documented in 6.5% of patients in group A and 8% of patients in group B. Conclusion: Oral treatment with nirmatrelvir/ritonavir in high-risk non-hospitalized patients was safe and effective in preventing the severe clinical progress of COVID-19 pneumonia. Early administration of antiviral agents in vulnerable outpatients combined with a full vaccination scheme is significant in order to avoid hospitalization and severe clinical outcomes

Smell and Taste Loss Recovery Time in COVID-19 Patients and Disease Severity

A significant proportion of people infected with SARS-CoV-2 report a new onset of smell or taste loss. The duration of the chemosensory impairment and predictive factors of recovery are still unclear. We aimed to investigate the prevalence, temporal course and recovery predictors in patients who suffered from varying disease severity. Consecutive adult patients diagnosed to be infected with SARS-CoV-2 via reverse-transcription–polymerase chain reaction (RT-PCR) at two coronavirus disease-2019 (COVID-19) Reference Hospitals were contacted to complete a survey reporting chemosensory loss, severity, timing and duration, nasal symptoms, smoking, allergic rhinitis, chronic rhinosinusitis, comorbidities and COVID-19 severity. In a cross-sectional study, we contacted 182 patients and 150 responded. Excluding the critically ill patients, 38% reported gustatory and 41% olfactory impairment (74% severe/anosmia). Most of the patients (88%) recovered their sense of smell by two months (median: 11.5 days; IQR: 13.3). For 23%, the olfactory loss lasted longer than a month. There were no significant differences in the prevalence and duration of chemosensory loss between groups of varying COVID-19 severity, and sexes (all p > 0.05). Moderate hyposmia resolved quicker than more severe loss (p = 0.04). Smell and taste loss are highly prevalent in COVID-19. Most patients recover fast, but nearly one out of ten have not recovered in two months

The Impact of the COVID-19 Pandemic on Antimicrobial Resistance and Management of Bloodstream Infections

Introduction: The pressure of the COVID-19 pandemic on healthcare systems led to limited roles of infectious diseases services, increased rates of irrational use of antimicrobials, and incidence of infections by multidrug-resistant microorganisms. The aim of the present study is to evaluate the incidence of antimicrobial resistance and the management of bloodstream infections before and during the COVID-19 pandemic at the University General Hospital of Alexandroupolis (Greece). Materials and Methods: This is a retrospective study conducted from January 2018 to December 2022. Data were collected from the University Microbiology Laboratory per semester regarding the isolated strains of Gram-positive and -negative bacteria in blood cultures and respiratory samples in hospitalized patients in medical and surgical wards and in the intensive care unit (ICU). Additionally, bloodstream infections with requested infectious disease consultations were reported (n = 400), determining whether these were carried out via telephone contact or at the patient’s bedside. Demographic data, comorbidities, focus of infection, antimicrobial regimen, duration of treatment, length of hospitalization, and clinical outcome were analyzed. Results: A total of 4569 strains of Gram-positive and -negative bacteria were isolated. An increasing trend was reported compared to the pre-pandemic period in the incidence of resistant Gram-negative bacteria, particularly in ICUs. Prior antimicrobial use and the rate of hospital-acquired infections were increased significantly during the pandemic. In the pre-pandemic period 2018–2019, a total of 246 infectious disease consultations were carried out, while during the period 2020–2022, the number was 154, with the percentage of telephone consultations 15% and 76%, respectively. Detection of the source of infection and timely administration of appropriate antimicrobial agents were more frequently recorded before the pandemic, and 28-day mortality was significantly reduced in cases with bedside consultations. Conclusion: The empowering of infectious disease surveillance programs and committees, rational use of antimicrobials agents, and bedside infectious disease consultations are vital in order to reduce the impact of infections caused by multidrug-resistant strains