Covid-19 - Navigating the Uncharted

Impact of COVID-19 pandemic-related restrictive measures on overall mental and physical health and well-being, specific psychopathologies and emotional states in representative adult Greek population: Results from the largest multi-wave, online national survey in Greece (COH-FIT)

BACKGROUND

Greece faced particular COVID-19-pandemic-related challenges, due to specific socio-cultural-economic/public-health factors and drastic restrictive policies.

OBJECTIVES

To understand trajectories of overall mental and physical health, well-being, emotional states and individual psychopathology in response to pandemic-related restrictive measures within general adult Greek population across the first two pandemic waves.

METHODS

Using multiple time-point cross-sectional data from the "Collaborative Outcomes study on Health and Functioning during Infection Times" (COH-FIT), we examined changes in outcomes from retrospective pre-pandemic ratings (T0) to three distinct intra-pandemic time points (lockdown 1: T1, between lockdowns: T2, lockdown 2: T3). Primary outcomes included WHO-5 well-being scores and a composite overall psychopathology "P-score", followed by a wide range of secondary outcomes.

RESULTS

10,377 participant responses were evaluated, including 2737 representative-matched participants. Statistically significant differences in well-being and overall psychopathology before and after quarantine (T0 vs. T1-T3), as well as across the assessed time frames (T1, T2, and T3) emerged in both samples. Global mental and physical health, individual psychopathology scores (anxiety, depression, PTSD, OCD, panic, mania, mood swings, sleep and concentration problems), emotional states (anger, helplessness, fear of infection, boredom, frustration, loneliness and overall stress scores), BMI and pain scores also showed statistically significant time differences in both samples, with the exemption of self-injury and suicidal attempt scores, showing lower intra-pandemic scores.

CONCLUSIONS

This is the largest multi-wave report on well-being, mental and physical health across different pandemic restriction periods in Greece, suggesting a substantial negative effect of lockdowns on most outcomes at least during the acute pandemic waves.

Lessons learned from the COVID-19 pandemic in Latin America: A Data Science standpoint

In the 21st century, the world has faced the devastating impacts of three acute respiratory diseases: Middle East respiratory Syndrome (MERS), Severe Acute respiratory Syndrome (SARS), and COVID-19, which evolved into a pandemic. These diseases have not only caused a large number of deaths but have also damaged the economies of the affected regions. Particularly, countries in the Latin American and Caribbean (LAC) region have faced additional challenges due to more significant social inequalities, limited access to Healthcare services, and precarious living conditions, and it is not clear how these challenges impacted the effects of the mitigation actions adopted by each country. However, this understanding is crucial to guide measures to mitigate Health and socioeconomic impacts if (or when) new acute respiratory diseases emerge, especially in these countries. A retrospective study was conducted to model the dynamics of variation in COVID-19 mortality in LAC countries and to analyze its association with vaccination strategies, containment measures, mobility restrictions, and socioeconomic factors. The study methodology applied clustering techniques that revealed two distinct clusters based on sociodemographic characteristics, followed by the application of XGBoost to model the dynamics of variation in deaths in the countries of each cluster over time. Finally, the SHAP Values technique was applied to understand the associations between mortality and factors such as vaccination, containment measures, and mobility restrictions. The study provides evidence that economic support and the completion of the vaccination scheme were especially relevant in reducing COVID-19 mortality. Two distinct groups of countries were detected, one characterized by a greater vulnerability. The most important interventions for understanding COVID-19 mortality varied between pre- and post-vaccination periods. In the pre-vaccination period, containment measures were the most important interventions for mortality in the less vulnerable countries, while population mobility was more important in the more vulnerable countries. In the post-vaccination period, vaccination coverage was the most important intervention for mortality in the less vulnerable countries, while containment measures impacted the more vulnerable countries.

Evaluation of the effect of the COVID-19 pandemic on depression, anxiety and psychological resilience in patients with primary immunodeficiency

BACKGROUND

Primary immunodeficiencies (PIDs) are a group of diseases that develop as a result of primary or congenital malfunction of the immune system and progress with chronic and/or recurrent bacterial, fungal, protozoal and/or viral infections. In this study, we aimed to examine the effects of the COVID-19 pandemic on depression, anxiety levels and psychological resilience in patients with PID and to compare them with those in controls.

METHODS

Seventy patients, aged 18-65 years, who were being followed up with a diagnosis of PID and 69 people as healthy control group, participated in our study. The participants were evaluated cross-sectionally once; sociodemographic data form, Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Resilience Scale for Adults (RSA), and COVID-19 Evaluation form were administered to the participants.

RESULTS

HAM-A and HAM-D scores were significantly higher in PID patients compared to controls (HAM-D: 5.5 vs. 3.0, p < 0.001; HAM-A: 6.0 vs. 4.0, p = 0.008). RSA was significantly lower in the patient group (RSA total: 122.5 vs. 136.0, p < 0.001), and pandemic-related risk perception was higher (PRPS: 33.9 vs. 28.3, p < 0.001). Sleep, appetite, and attention-related disturbances were also more common in the patient group. Multivariate regression analyses revealed that PID diagnosis was an independent predictor of increased depression severity (HAM-D), lower psychological resilience (RSA), and greater pandemic-related risk perception. Female sex was independently associated with higher anxiety severity (HAM-A). A personal psychiatric history and greater number of comorbidities were also significant predictors of psychological vulnerability, particularly in relation to depression and anxiety.

CONCLUSION

Given the observed associations between PID and increased levels of depression, anxiety, and reduced psychological resilience during the pandemic, clinicians may consider heightened vigilance for psychological symptoms in this population during times of public health crisis.

Analyzing Physical to Virtual Religious Practices on Filipino Catholic Religiosity and Spirituality During the COVID-19 Pandemic

This paper investigates the shift from physical to virtual religious practices due to the COVID-19 pandemic, which has affected how Filipino Catholics attend their daily masses, celebrations, and other sacraments and sacramentals. The researchers use expository writing and content analysis to analyze the collected data from documents discussing Filipino Catholic spirituality and religiosity and the transition from physical to virtual religious practices. First, we will discuss Filipino Catholic spirituality and religiosity. Second, we present the transition from physical to virtual Catholic religious practices. Lastly, we explain the possible effects of virtual religious practices on expressing religiosity and enriching the spirituality of Filipinos. Hence, this paper ends by stating that virtual religious practices do not have the same intimacy as physical religious practices but still help the faithful encounter God.

A model based on PT-INR and age serves as a promising predictor for evaluating mortality risk in patients with SARS-CoV-2 infection

COVID-19 caused by the coronavirus SARS-CoV-2 has resulted in a global pandemic. Considering some patients with COVID-19 rapidly develop respiratory distress and hypoxemia, early assessment of the prognosis for COVID-19 patients is important, yet there is currently a lack of research on a comprehensive multi-marker approach for disease prognosis assessment. Here, we utilized a large sample of hospitalized individuals with COVID-19 to systematically compare the clinical characteristics at admission and developed a nomogram model that was used to predict prognosis. In all cases, those with pneumonia, older age, and higher PT-INR had a poor prognosis. Besides, pneumonia patients with older age and higher PT-INR also had a poor prognosis. A nomogram model incorporating presence of pneumonia, age and PT-INR could evaluate the prognosis in all patients with SARS-CoV-2 infections well, while a nomogram model incorporating age and PT-INR could evaluate the prognosis in those with pneumonia well. Together, our study establishes a prognostic prediction model that aids in the timely identification of patients with poor prognosis and helps facilitate the improvement of treatment strategies in clinical practice in the future.

Synthesizing a pragmatic and systemized measure of universal health coverage: verifying the circumstances of mortality CATegories of death investigated by verbal autopsy

Background

Vital data on births, deaths, and causes of death are primarily captured by civil registration and vital statistics systems, which are vastly lacking or inadequately operating in resource-constrained settings. Out-of-health facility deaths remain prevalent and often pass without adequate medical certification, leading to gaps in understanding the medical, social, logistical, and health system circumstances contributing to these deaths. Verbal autopsy (VA), as a standardized and scalable method, is well designed to fill gaps by eliciting causes of death information at the population level. Circumstances Of Mortality CATegories (COMCAT) is a newly integrated concept within VA to identify and quantify likely circumstantial factors contributing to deaths, mainly from social and health system aspects. COMCAT, previously tested in South Africa and Saudi Arabia, show potential to systematically categorize circumstances of death at a population scale. This study intends to verify the process of COMCAT by assessing its plausibility and relevance in generating sensible applications in Indonesia.

Methods

InterVA-5, a machine learning-based VA tool, was used for processing and interpreting medical and non-medical (COMCAT) causes of death for data collected between 2017 and 2021 in the Sleman Health and Demographic Surveillance System. Cause-specific mortality fractions and the corresponding COMCAT categories were derived for each cause of death.

Results

Lack of recognition of the illness severity among families attributed mostly to deaths in the Sleman region. The proportions and ranks of each COMCAT were consistent with the known health information of the population in the setting, which speaks to the plausibility of these findings. The novel geo-mapping component of this tool application adds value to monitoring "hot spots" and their social and health system determinants.

Conclusion

Geo-temporal COMCAT information shows sensible applications of the utility of the VA by producing plausible circumstantial information on population mortality in time and space.

Satisfaction with and factors influencing rural residents' government responses to COVID-19 in the post-pandemic era

BACKGROUND

China lifted its strict COVID-19 lockdown policies on December 8, 2022, transitioning to a series of milder preventive measures. Understanding the factors influencing rural residents' satisfaction with these policies is crucial for strengthening the government's ability to effectively respond to public health emergencies such as the COVID-19 pandemic.

METHODS

A cross-sectional survey on government policy satisfaction was conducted from January 28 to 31, 2023, and a convenience sampling method was used to recruit 1,276 rural residents across 27 provinces. Chi-square tests and logistic regression analysis were employed to identify the factors influencing rural residents' satisfaction with the government's pandemic response, with the significance level set at α = 0.05.

RESULTS

A total of 59.87% of the participants reported being satisfied with the government's pandemic response. Logistic regression analysis revealed that migrant workers had lower levels of satisfaction with government pandemic policies (OR = 0.56, 95% CI: 0.40-0.80). The worse the government's ability to treat COVID-19 patients is, the lower their level of satisfaction (OR = 0.51, 95% CI: 0.38-0.70). Conversely, rural residents who exercised regularly presented higher levels of satisfaction (OR = 1.55, 95% CI: 1.19-2.01). Satisfaction was positively associated with key control measures, including health screenings (OR = 2.19, 95% CI: 1.48-3.22), pandemic control teams (OR = 2.21, 95% CI: 1.51-3.23), and restrictions on gatherings (OR = 1.57, 95% CI: 1.12-2.19). Inadequate health advocacy was negatively correlated with satisfaction (OR = 0.66, 95% CI: 0.44-0.99). Significant regional differences were observed, with residents in eastern China (OR = 1.57, 95% CI: 1.17-2.12) and western China (OR = 1.90, 95% CI: 1.37-2.63) reporting higher levels of satisfaction than those in central China did.

CONCLUSION

More than half of rural residents are satisfied with the government's pandemic response, but significant room for improvement remains. Notably, the lower satisfaction levels among rural residents in central China warrant greater attention. This study identifies various factors influencing satisfaction with government pandemic policies, offering a scientific reference for enhancing responses to public health emergencies such as the COVID-19 pandemic.

Epidemiology, Clinical Significance, and Diagnosis of Respiratory Viruses and Their Co-Infections in the Post-COVID Era

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel human coronavirus, emerged in late 2019 and rapidly evolved into a pandemic around the world. The coronavirus disease (COVID-19) pandemic has dramatically changed the epidemiology and seasonality of other traditional respiratory viruses, e.g., influenza, respiratory syncytial virus, enterovirus, etc. These traditional respiratory viruses have transmission mode and clinical symptoms similar to SARS-CoV-2 but may differ in clinical outcomes and management. Co-infection between SARS-CoV-2 and one or more traditional respiratory viruses have been reported in the literature but have shown mixed evidence in clinical outcomes. With SARS-CoV-2 evolving into mild Omicron variants, it is believed that SARS-CoV-2 co-circulates with other respiratory viruses, which in turn affect the epidemiology and clinical course of respiratory viral infections. In response to these changes, multiplex molecular tests for SARS-CoV-2 and one or more traditional respiratory viruses are attracting more attention in the field and have been developed into a variety of testing modalities. In this review, we describe the seasonality (i.e., in the Northern Hemisphere), epidemiology, and clinical significance of traditional respiratory viruses and their co-infection with SARS-CoV-2 in the post-COVID era. Furthermore, we review commonly used multiplex molecular tests and their applications for the detection of respiratory viruses and their co-infections. Altogether, this review not only sheds light on the epidemiology and clinical significance of respiratory viral infections and co-infections in the post-COVID era, and but also provides insights into the laboratory-based diagnoses of respiratory viral infections using multiplex molecular testing.

MicroRNAs in HIV infection: dual regulators of viral replication and host immunity

MicroRNAs (miRNAs) are small non-coding RNAs that play a crucial role in regulating gene expression by binding to target messenger RNAs (mRNAs), leading to their degradation or translational repression. Over the past few years, significant progress has been made in understanding the role of miRNAs in various biological processes, including viral infections such as human immunodeficiency virus (HIV). HIV infection is characterized by a complex interaction between the virus and the host's immune system, where miRNAs have emerged as key regulators. MiRNAs influence HIV infection by modulating both viral replication and the host immune response. Researchers have identified several host miRNAs that suppress or enhance HIV replication by targeting viral genes or host factors essential for the virus life cycle. Conversely, HIV has evolved mechanisms to manipulate the host's miRNA machinery to its advantage. The virus can downregulate or upregulate specific host miRNAs to create a more favorable environment for replication and persistence. Moreover, HIV infection can alter the expression profiles of various miRNAs in infected cells, which can contribute to immune dysregulation and disease progression. Dysregulation of miRNAs is associated with HIV-associated complications, such as neurocognitive disorders and cardiovascular diseases. Understanding the specific roles of miRNAs in HIV pathogenesis could lead to the development of novel therapeutic strategies, such as miRNA-based therapies, to control HIV infection and its associated comorbidities. Understanding the role of miRNAs in HIV infection reveals their significant influence on the complex interactions between the virus and the host, impacting the course of infection and disease progression. Also, continued research in miRNA-mediated mechanisms in HIV holds the potential for uncovering new insights into viral pathogenesis and developing innovative therapeutic approaches.

Patients with chronic hepatitis B under nucleos(t)ide analog therapy with Omicron BA.5 infection: A retrospective study in South China

Background and aims

Clinical data regarding patients with chronic hepatitis B (CHB) after Omicron BA.5 infection are currently limited. This study aimed to assess the clinical characteristics of patients with CHB and Omicron BA.5 infection in South China.

Methods

This retrospective study was conducted from January to March 2023 in a cohort of 485 healthy individuals and 553 patients with CHB. Clinical features, encompassing COVID-19-related symptoms, levels of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies, vaccination status, liver functions, and virological markers of hepatitis B virus (HBV) infection were measured.

Results

COVID-19-related symptom patterns were similar in both groups, except for fever, which was notably less prevalent (85.4% vs. 90.4%, P = 0.047) among patients with CHB who experienced a significantly shorter duration of fever (median 2.2 (25th-75th percentile, 1.0-3.0) days vs. 2.3 (1.0-3.0) days, P = 0.048) and a shorter time for symptom relief (9.2 (5.0-14.0) vs. 11.1 (5.0-14.0) days, P = 0.015). The levels of SARS-CoV-2 antibodies were comparable between the two groups but increased after booster vaccinations. In patients with CHB, globulin (GLB) and hepatitis B envelope antibody levels were significantly increased after Omicron BA.5 infection, regardless of nucleos(t)ide analog regimens comparing entecavir (ETV) with tenofovir (TFV). Patients with CHB treated with TFV had significantly higher levels of SARS-CoV-2 antibodies than those treated with ETV (1065.1 (346.9-1188.5) COI vs. 765.5 (24.5-1119.1) COI, P = 0.025).

Conclusions

No significant exacerbation of COVID-19 symptoms was observed in conjunction with the efficacy of COVID-19 booster vaccinations. There were no notable alterations in liver functions except for GLB. HBV reactivation, as evidenced by increased HBV DNA, was observed among patients with CHB after Omicron BA.5 infection. These changes were not affected by ETV versus TFV administration; however, TFV resulted in a significant increase in SARS-CoV-2 antibody levels. Further studies are required to improve care and therapeutics for patients with CHB who contracted COVID-19.

Estimating effective reproduction numbers using wastewater data from multiple sewersheds for SARS-CoV-2 in California counties

The effective reproduction number serves as a metric of population-wide, time-varying disease spread. During the early years of the COVID-19 pandemic, this metric was primarily derived from case data, which has varied in quality and representativeness due to changes in testing volume, test-seeking behavior, and resource constraints. Deriving nowcasting estimates from alternative data sources such as wastewater provides complementary information that could inform future public health responses. We estimated county-aggregated, sewershed-restricted wastewater-based SARS-CoV-2 effective reproduction numbers from May 1, 2022 to April 30, 2023 for five counties in California with heterogeneous population sizes, clinical testing rates, demographics, wastewater coverage, and sampling frequencies. We used two methods to produce sewershed-restricted effective reproduction numbers, both based on smoothed and deconvolved wastewater concentrations. We then population-weighted and aggregated these sewershed-level estimates to arrive at county-level effective reproduction numbers. Using mean absolute error (MAE), Spearman's rank correlation (ρ), confusion matrix classification, and cross-correlation analyses, we compared the timing and trajectory of our two wastewater-based models to: (1) a publicly available, county-level ensemble of case-based estimates, and (2) county-aggregated, sewershed-restricted case-based estimates. Both wastewater models demonstrated high concordance with the traditional case-based estimates, as indicated by low mean absolute errors (MAE ≤ 0.09), significant positive Spearman correlation (ρ ≥ 0.66), and high confusion matrix classification accuracy (≥ 0.81). The relative timings of wastewater- and case-based estimates were less clear, with cross-correlation analyses suggesting strong associations for a wide range of temporal lags that varied by county and wastewater model type. This methodology provides a generalizable, robust, and operationalizable framework for estimating county-level wastewater-based effective reproduction numbers. Our retrospective evaluation supports the potential usage of real-time wastewater-based nowcasting as a complementary epidemiological tool for surveillance by public health agencies at the state and local levels. Based on this research, we produced publicly available wastewater-based nowcasts for the California Communicable diseases Assessment Tool (calcat.cdph.ca.gov).

Variability of COVID-19 mortality in Honduras: influence of sociodemographic factors

BACKGROUND

In Central America, Honduras experienced a significant increase in SARS-CoV-2 infections between March 11, 2020, and January 26, 2022. Although limited research has been conducted on the impact of the COVID-19 pandemic on populations in Central American countries, this study seeks to contribute to the existing body of knowledge in the region. The objective of this study was to investigate the variability of COVID-19 mortality in Honduras and the impact of sociodemographic factors.

METHODS

A cross-sectional and ecological study, using data from cases collected by the National Risk Management System (SINAGER) and recorded by the Demographic Observatory of the National Autonomous University of Honduras (ODU) between March 11, 2020, and January 26, 2022. Sociodemographic variables were obtained from the 2013 XVII Population and VI Housing Census by the National Institute of Statistics (INE). Age-adjusted case and COVID-19 mortality rates by sex were calculated. To explain the potential causes of variability, multilevel logistic regression models were constructed, considering individual and contextual variables.

RESULTS

A total of 513,416 COVID-19 cases were included, of which 98 % (503,176) survived and 2 % (10,240) died. The results showed differences in COVID-19 mortality rates between municipalities and departments. The multilevel model revealed that age (OR: 1.0737; 95 % CI: [1.0726; 1.0749]) and sex (OR: 0.7434; 95 % CI: [0.7027; 0.7841]) were significantly associated with COVID-19 mortality, with men being more likely to die. Among departments, the significant contextual factors were the illiteracy rate and the percentage of the rural population, both of which were associated with higher COVID-19 mortality (OR: 1.0850; 95 % CI: [1.0511; 1.1189] and OR: 1.0234; 95 % CI: [1.0146; 1.0323]), while the percentage of the active population (working age people) was associated with a decrease in COVID-19 mortality (OR: 0.9768; 95 % CI: [0.9591; 0.9944]). The intraclass correlation coefficient (ICC) showed a reduction in variability attributable to the variation between departments, with a final ICC of 0.68 % .

CONCLUSIONS

Differences in COVID-19 mortality were found between the different departments, partly explained by sociodemographic factors. The results of this study show that, in addition to individual characteristics, population-level socioeconomic and educational factors influence COVID-19 mortality. Multilevel analysis is highly useful for providing evidence to improve approaches in future pandemics.

Effects of COVID-19 Infection on Endothelial Vascular Function

Most studies analyzing data from patients who experienced at least one episode of acute COVID-19 infection have attributed the cascade of immediate and late complications to disruption of the inflammatory system and neutrophil activity in particular. Among the various functions of neutrophils is the release of pro-inflammatory mediators, including interleukin-6 (IL-6). Oxidative stress induced by pro-inflammatory mediators secreted by neutrophils leads to vascular endothelial dysfunction. Neutrophil counts and the neutrophil-to-lymphocyte ratio (NLR) are directly associated with COVID-19 patient survival, with higher values correlating with increased mortality. To assess endothelial dysfunction secondary to COVID-19 infection, we conducted a retrospective study involving two patient cohorts, each comprising 99 participants: one group with a history of COVID-19 infection and another without. The study aimed to demonstrate the presence of endothelial dysfunction in patients with moderate COVID-19 infection using flow-mediated dilatation (FMD) of the brachial artery and to evaluate its correlation with key inflammatory markers (erythrocyte sedimentation rate-ESR, fibrinogen, NLR, IL-6). FMD values were significantly reduced (p < 0.0001) in post-COVID-19 patients compared to those without prior infection. ESR (p < 0.0001), fibrinogen (p < 0.0001), C-reactive protein (CRP) (p < 0.0001), leukocyte count (p < 0.0001), and granulocyte count (p < 0.0001) were inversely correlated with FMD values. Among post-COVID-19 patients, all analyzed parameters demonstrated a statistically significant impact on FMD, with ESR showing the strongest effect, accounting for nearly 63% of the dependency. ANOVA testing confirmed an inverse association between NLR quartiles and FMD, as well as between IL-6 levels and FMD. In conclusion, this study highlights the presence of endothelial dysfunction in post-COVID-19 patients, as assessed by FMD, and demonstrates statistically significant inverse correlations between FMD values, IL-6 levels, and the neutrophil-to-lymphocyte ratio.

Impact of myocardial injury on cardiovascular complications in hospitalized patients with COVID-19: insights from Latin America

Introduction

Viral infection by SARS-CoV2 is a pandemic affecting over 600 million people worldwide. One of five hospitalized patients may present myocardial injury, strongly associated with disease severity and mortality.

Methodology

Retrospective cross-sectional study of hospitalized COVID-19 patients diagnosed between May 01, 2020, and June 30, 2021, from the database of the Registro Latinoamericano de Enfermedad Cardiovascular y COVID-19 (CARDIO COVID 19-20) with a troponin value recorded during hospitalization. A descriptive analysis of sociodemographic and clinical characteristics was performed. Bivariate analysis was conducted according to the presence or absence of myocardial injury. Survival analysis was made using Kaplan-Meier curves, by the presence of myocardial injury. A multivariate Poisson regression model was performed to determine factors associated with mortality. Statistical analyses were performed using the RStudio V.1.4.1717 package.

Results

A total of 2,134 patients were included, 64.2% were male, and 911 patients had myocardial injury. The median age of the total population was 61 years. Individuals with myocardial injury had a higher prevalence of hypertension, diabetes, and dyslipidemia. Survival probability was lower in this subgroup. Patients with myocardial injury had a 1.95 times higher risk of death. Age, male sex, chronic kidney disease, arrhythmias, decompensated heart failure, requirement of inotropic/vasopressor, and invasive mechanical ventilation were related to higher mortality risk in patients with myocardial injury.

Conclusion

Patients with COVID-19 and myocardial injury exhibit a broad spectrum of cardiac abnormalities. Myocardial injury is associated with a higher disease severity and risk of in-hospital mortality. This multicenter study uniquely represents data from 13 Latin American countries, offering regional insights into the impact of myocardial injury during the COVID-19 pandemic.

Perioperative severity of acute appendicitis during the confinement related to SARS COVID-19: a retrospective comparative cohort

OBJECTIVE

To evaluate the perioperative severity of acute appendicitis during the COVID-19 pandemic compared to the same periods in 2018 and 2019 in the Nancy-Metz region, France. Acute appendicitis is a common surgical emergency that can lead to severe complications if not treated promptly. The COVID-19 pandemic and subsequent lockdowns resulted in reduced hospital visits, potentially delaying treatment for appendicitis and increasing perioperative severity.

METHODS

This retrospective, bicentric cohort study included 634 adult patients who underwent emergency appendectomy at the Nancy University Hospital and Metz Regional Hospital. The study compared patients from the pandemic period (March 17, 2020, to December 14, 2020) with those from the same periods in 2018 and 2019. The primary outcome was perioperative severity, defined by a Gomes score ≥ 3 and/or a Clavien-Dindo classification ≥ 3. Secondary outcomes included time to treatment, severity of biological inflammatory syndrome, postoperative complications, and hospitalization metrics. Logistic regression analyses were performed with adjustments for ASA scores.

RESULTS

The study included 194 patients from the COVID-19 cohort and 440 from the non-COVID cohort. The perioperative severity was higher during the COVID period (33.5% vs. 25.9%), though this difference was not statistically significant (p = 0.0845). Secondary outcomes such as time to treatment, severity of the inflammatory syndrome, and postoperative complications did not show significant differences between cohorts. However, the duration of postoperative antibiotic therapy was longer during the COVID period (6 days vs. 5 days, p = 0.0410).

CONCLUSION

The COVID-19 pandemic led to a non-significant increase in perioperative severity of acute appendicitis. Despite the challenges posed by the pandemic, the French healthcare system maintained effective management of surgical emergencies, with no significant increase in postoperative complications. Further research is required to explore the broader impact of the pandemic on the management of appendicitis.

SARS-CoV-2 Infection Association with Atherosclerotic Plaque Progression at Coronary CT Angiography and Adverse Cardiovascular Events

Background Patients with acute SARS-CoV-2 infection are reportedly at increased risk for future cardiovascular events; the mechanism underlying this risk remains unclear. Purpose To evaluate the impact of SARS-CoV-2 infection on coronary inflammation and plaques by using coronary CT angiography (CCTA) and the impact on clinical outcomes. Materials and Methods This retrospective analysis of a prospective study included consecutive patients who underwent serial CCTA between September 2018 and October 2023. The quantitative total and compositional percent atheroma volume (PAV) and annualized PAV change, presence of high-risk plaque, and attenuation of lesion-specific pericoronary adipose tissue (PCAT) at baseline and follow-up were compared between lesions in patients with and without SARS-CoV-2 infection. Relationships between SARS-CoV-2 infection and target lesion failure, which is a composite of cardiac death, target lesion myocardial infarction, and clinically driven target lesion revascularizations, were assessed with Cox models and log-rank tests. Results In 803 patients (mean age, 63.9 years ± 10.1 [SD]; 543 [67.6%] male patients), 2108 coronary artery lesions were evaluated in patients with SARS-CoV-2 infection (n = 690) and 480 coronary artery lesions were evaluated in patients without SARS-CoV-2 infection (n = 113). Compared with lesions in patients without SARS-CoV-2 infection, lesions in patients with SARS-CoV-2 infection demonstrated more rapid progression of overall PAV (0.90% per year ± 0.91 vs 0.62% per year ± 0.68, respectively; P < .001) and noncalcified PAV (0.78% per year ± 0.79 vs 0.42% per year ± 0.45, respectively; P < .001). The incidence of becoming high-risk plaque (21.0% [442 of 2108] vs 15.8% [76 of 480]; P = .03) and PCAT attenuation of -70.1 HU or higher (27.1% [571 of 2108] vs 19.8% [95 of 480]; P < .001) at follow-up was also greater in lesions in patients with SARS-CoV-2 infection (P < .001), despite similar prevalence at baseline. Lesions in patients with COVID-19 had a higher risk of target lesion failure (10.4% vs 3.1%, respectively; adjusted hazard ratio, 2.90; 95% CI: 1.68, 5.02; P < .001). Conclusion SARS-CoV-2 infection was associated with a more rapid progression of lesion-based plaque volume and an increase in incidence of becoming high-risk plaque. Coronary plaques among patients who experienced COVID-19 were more prone to having an elevated risk of target lesion failure. Clinical trial registration no. NCT05380622 © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Weir-McCall and Bell in this issue.

Quercetin: A Flavonoid with Potential for Treating Acute Lung Injury

In intensive care units, acute lung injury (ALI) is a syndrome that is frequently encountered. It is associated with a high rate of morbidity and mortality. Despite the extensive research conducted by the medical community on its treatment, no specific effective drugs have been identified. Quercetin is a natural flavonoid with many biological activities and pharmacological effects. Research indicates that Quercetin can modulate various targets and signaling pathways, inhibiting oxidative stress, inflammatory responses, ferroptosis, apoptosis, fibrosis, and bacterial and viral infections in ALI. This regulation suggests its potential therapeutic application for the condition. Currently, there is no comprehensive review addressing the application of Quercetin in the treatment of ALI. This paper begins with a classification of ALI, followed by a detailed summary of the mechanisms through which Quercetin may treat ALI to evaluate its potential as a novel therapeutic option.

Rapid SARS-CoV-2 sensing through oxygen reduction reaction catalysed by Au@Pt/Au core@shell nanoparticles

The development of rapid, accurate, sensitive, and low-cost diagnostic methods for COVID-19 detection in real-time is the unique way to control infection sources and monitor illness progression. In this work, we propose an electrochemical biosensor for the rapid and accuracy diagnosis of COVID-19, through the determination of ORF1ab specific sequence. The biosensor is based on the immobilization of a thiolated sequence partially complementary (domain 1) to ORF1ab on gold screen-printed electrodes and the use of bifunctional Au@Pt/Au core@shell nanoparticles modified with a second thiolated sequence partially complementary to ORF1ab (domain 2) as electrochemical indicator of the hybridization of DNA sequences. The synthesized Au@Pt/Au nanoparticles consist of an Au core, a shell of Pt (Au@Pt NPs), that provides an excellent electrocatalytic activity toward the oxygen reduction reaction (ORR) even after formation of hybrid biomaterials by modification, through the Au protuberances growth on the NPs surface, with an oligonucleotide with recognition ability. The ORR electrochemical activity, enhanced by the label element (Au@Pt/Au NPs), has been employed, for the first time, as indicator of the hybridization event. Based on this strategy, target sequences of the SARS-CoV-2 virus have been detected with a detection limit of 32 pM. The selectivity of the biosensor was confirmed by analysing ORF1ab sequence in the presence of DNA sequences from other viruses. The biosensor has been successfully applied to the direct detection of the virus in non-amplified samples of nasopharyngeal swabs from infected and non-infected patients. Results compare well with those obtained through RT-qPCR but our method is more rapid since does not need any amplification process.

Wearable threads for monitoring sanitizer quality using dye displacement assay

This study employs zero-cost (≈0.01 $) and durable thread-based devices to evaluate the quality of simulated and commercial sanitizer samples through dye displacement assay (DDA). A diverse range of sanitizer compositions, including ethanol concentrations of 55%, 75%, and 95% (v/v), were analysed. This investigation encompasses an assessment of the marker type (Doms and Hauser brands) on the migration distance of the dye region marked on thread devices. Our results demonstrate a proportional increase in the migration distance of the dye with increasing ethanol concentrations due to a decrease in the coefficient of viscosity and solvation power of ethanol on dye molecules. Additionally, a field trial for the thorough assessment of commercial sanitizer quality using thread-based devices further underscores the efficacy of this methodology. A calibration plot for a braided thread with Doms marker dye provides a reliable means to quantitatively assess the ethanol content in different commercial sanitizer compositions. Our findings collectively highlight the significance of this innovative method as a valuable tool for quality control and assessment for public health and hygiene as well as for preparing us for another pandemic.

Rational Design of Macrocyclic Noncovalent Inhibitors of SARS-CoV-2 Mpro from a DNA-Encoded Chemical Library Screening Hit That Demonstrate Potent Inhibition against Pan-Coronavirus Homologues and Nirmatrelvir-Resistant Variants

The recent global COVID-19 pandemic has highlighted treatments for coronavirus infection as an unmet medical need. The main protease (Mpro) has been an important target for the development of SARS-CoV-2 direct-acting antivirals. Nirmatrelvir as a covalent Mpro inhibitor was the first such approved therapy. Although Mpro inhibitors of various chemical classes have been reported, they are generally less active against nirmatrelvir-resistant variants and have limited pan-coronavirus potential, presenting a significant human health risk upon future outbreaks. We here present a novel approach and utilized DNA-encoded chemical library screening to identify the noncovalent Mpro inhibitor 5, which demonstrated a distinct binding mode to nirmatrelvir. A macrocyclization strategy designed to lock the active conformation resulted in lactone 12 with significantly improved antiviral activity. Further optimization led to the potent lactam 26, which demonstrated exceptional potency against nirmatrelvir-resistant variants as well as against a panel of viral main proteases from other coronaviruses.

How Social Connectedness Helps Patients Stay Home After Hospital at Home Enrollment: A Mixed Methods Study

BACKGROUND

While enrolled in Hospital at Home (HaH) programs, patients rely on their social network to provide supportive behaviors that are routinely provided by hospital staff in the inpatient setting.

OBJECTIVE

This study investigated how social connectedness is associated with patient outcomes in a HaH program.

DESIGN

The explanatory iterative sequential mixed methods design included an electronic health record review to collect quantitative measures to describe the severity of patient illness and healthcare utilization and then qualitative interviews to explain quantitative findings.

PARTICIPANTS

The quantitative phase included 100 patients (18 years or older) admitted to the hospital who were subsequently enrolled in the HaH program. In the qualitative phase, 33 of the 100 patients participated in semi-structured interviews.

ANALYSIS

Qualitative data was analyzed using the Sort & Sift, Think & Shift method. Integrated analysis included merged data displays of healthcare utilization data and patient descriptions of their care and genogram-type illustrations to enable variable-oriented analysis of structural support. We then examined patient narratives by two variables: life course and care elevation, to understand differences in the trajectories of six subsets of patients as identified by the quantitative data.

KEY RESULTS

Three factors prompted patients to enroll in HaH: low attention from hospital staff during hospital stay; loneliness and isolation during hospital stay; and family encouragement to enroll. After discharge, social support within the home structure facilitated recovery during HaH. Conversely, HaH patients with limited support within the home were more likely to be readmitted.

CONCLUSIONS

Structural social connectedness facilitates patient recovery in HaH. Before enrolling patients in HaH, clinicians should take an in-depth social history, including questions about social/familial roles, household responsibilities, and technology acceptance. Clinicians should engage formal and informal caregivers in these conversations early and communicate a clear picture of what caregivers should do to support the patient through recovery.

Prognostic value of serum amyloid A protein as a biomarker in the diagnosis of 2019 novel coronavirus disease (COVID-19)

BACKGROUND

The current study aimed to evaluate the prognostic value of serum amyloid A protein)SAA(protein as a biomarker in diagnosing 2019 novel coronavirus disease)COVID-19(infection.

METHODS

The study was conducted on 123 patients with definitive COVID-19 infection referred to Shahid Beheshti and Sina hospitals in Hamedan province, Iran. Five-milliliter blood samples were taken from all included patients and serum was isolated using a centrifuge at 10,000 rpm for 10 min. Laboratory tests were conducted, including c-reactive protein (CRP), Erythrocyte Sedimentation Rate (ESR), potassium level, sodium blood test, platelets (PLT), complete blood count (CBC), lymphocyte count, and neutrophil count. The SAA enzyme-linked immunosorbent assay (ELISA) Kit was applied to measure the SAA level in serum samples.

RESULTS

123 patients included 73 males and 50 females, age ±50. Sixty-six (53.7 %) patients had negative CRP while 80 (65 %) patients had normal ESR. Potassium levels were not normal among 111 (94.9 %) patients. Seventy-seven (63.1 %) patients had normal CBC, while 108 (87.8 %) patients had neutrophils above the normal range. 94 (97.9 %) patients over the age of 50 were positive for SAA. In terms of gender, men were the most frequent patients with SAA. There was a statistically significant relationship between the serum level of SAA and outcomes of patients with COVID-19 (p = 0.0001). 94 % of patients with SAA ≤50 were recovered from COVID-19 infection. The sensitivity rate of SAA compared to polymerase chain reaction (PCR) and computed tomography scan (CT scan) tests was 93 % and 99 %, respectively. Moreover, the accuracy of SAA compared to PCR and CT scan tests was 52 % and 96 %, respectively.

CONCLUSION

Results indicate the SAA is a sensitive, but not specific biomarker in the early detection of COVID-19. The quantitative levels of SAA can be useful in predicting treatment outcomes among patients with COVID-19.

Culturally Adapted Lifestyle Intervention for South Asian Adults With Cardiovascular Risk Factors: The SAHELI Randomized Clinical Trial

Importance

South Asian adults in the US experience excess cardiovascular disease (CVD) compared with other racial and ethnic groups. The effectiveness and reach of guideline-recommended lifestyle interventions have not been evaluated in this population.

Objective

To evaluate whether a culturally adapted, group lifestyle intervention will improve CVD risk factors more effectively than written health education materials among US South Asian adults.

Design, Setting, and Participants

This single-blind randomized clinical trial was conducted from March 6, 2018, to February 11, 2023 at community sites in the Chicago, Illinois, metropolitan area. South Asian adults aged 18 to 65 years who were overweight or obese, had no history of CVD events, and had at least 1 additional CVD risk factor (hypertension, dyslipidemia, prediabetes, or diabetes) were eligible for inclusion.

Intervention

A 16-week, culturally adapted, group-based lifestyle intervention led by community health coaches. Lifestyle modification counseling was delivered in English, Gujarati, Hindi, and Urdu. Participants tracked their diet and physical activity (PA) and received 4 optional group maintenance sessions between months 5 and 11 of follow-up. The intervention was delivered in person prior to the onset of the COVID-19 pandemic and via videoconference starting in March 2020. The control group received written health education materials, delivered monthly.

Main Outcomes and Measures

Primary outcomes were the between-group differences in CVD risk factor changes from baseline to 12 months, including weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), glycated hemoglobin (HbA1c), and total cholesterol, estimated using multivariate mixed-effects regression models. Secondary outcomes were self-reported diet quality, PA, and self-efficacy, estimated using univariate mixed-effects regression models.

Results

Among 549 randomized participants, 318 (57.9%) were women, and mean (SD) participant age was 49.2 (9.5) years. Mean differences in CVD risk factor changes from baseline to 12 months in the intervention vs control group were calculated for weight (mean difference, -0.07 kg; 95% CI, -0.55 to 0.42), SBP (mean difference, 0.47 mm Hg; 95% CI, -1.85 to 2.79), DBP (mean difference, 0.44 mm Hg; 95% CI, -1.06 to 1.95), cholesterol (mean difference, -2.47 mg/dL; 95% CI, -8.51 to 3.57), and HbA1c (mean difference, -0.07%; 95% CI -0.20% to 0.07%). Intervention participation was associated with greater improvements in dietary quality, PA, and self-efficacy than control.

Conclusions and Relevance

In the SAHELI randomized clinical trial, a culturally adapted, group lifestyle intervention was not more effective than written health education materials for CVD risk factor reduction among US South Asian adults, but the intervention was associated with small improvements in self-reported health behaviors. Effective CVD prevention interventions for this elevated-risk population require further investigation.

Trial Registration

ClinicalTrials.gov Identifier: NCT03336255.

Intention to adherence to social distancing for prevention of Covid-19 in the urban areas of southern Iran: a structural equation modeling (SEM) analysis of theory of planned behavior

BACKGROUND

Social distancing is a key behavior to minimize and controlling COVID-19 infections. The current study applied an integrated Theory of Planned Behavior to identify the determinants of social distancing behavior, and the processes involved, in the context of the COVID-19 pandemic.

METHODS

a cross-sectional study was conducted in Southern Iran among 1000 people from Shiraz by employing a convenience sampling technique. Data were collected using a pre-tested and structured questionnaire based on the main constructs of the Theory of Planned Behavior. Statistical analysis was done using IBM SPSS software version 22 and Amos version 24. Level of statistical significance was declared at a P-value of less than 0.05.

RESULTS

according to the results, the subjective norms (F = 2.696, effect size = 0.139) and attitude (F = 3.582, effect size = 0.155) play an important role in the samples' PBC (P ≤ 0.05). Final adjusted structural equation model of the effects of independent variables (Gender, subjective norms, attitude) on samples' intention to adherence social distancing for prevention of Covid-19 with the mediating role of one main variable of PBC. The PBC alone can be an important factor in creating intensive behavior in the samples (F = 3.560, effect size = 0.18).

CONCLUSION

current findings highlight the importance of "attitude, subjective norms and PBC" as determinants of social distancing intention. Future research on long-range predictors of social distancing behavior and reciprocal effects in the integrated model is warranted. This evidence is relevant to public and private organizations in the process of developing strategies to promote and engage the population in adopting the behavior of "Adherence to Social Distancing" in Iran.

Age Differences and Prevalence of Comorbidities for Death and Survival in Patients with COVID-19: A Single-Center Observational Study in a Region of Southern Italy

The SARS-CoV-2 outbreak has resulted in a considerable number of deaths worldwide. The virus damages the pulmonary artery endothelium, leading to a condition known as microvascular pulmonary inflammatory thrombotic syndrome (MPITS), which can be fatal and cause multiple organ failure. The presence of preexisting comorbidities has been shown to significantly impact the severity and prognosis of patients with SARS-CoV-2 infection. The objective of this study was to compare the age groups of patients with coronavirus disease 2019 (COVID-19) and to identify the prevalence of comorbidities associated with death and survival in an area of southern Italy. The data set consisted of 1985 patients with confirmed cases of SARS-CoV-2 infection who were admitted to the A.O.U. San Giovanni di Dio e Ruggi d'Aragona Hospital in Salerno between January 2021 and December 2022. The results were presented for the overall population and stratified by outcome and age group. All analyses were performed using the XLSTAT (Lumivero, 2024, Paris, France) and STATA software (release 16.1, StataCorp LLG, College Station, TX, USA, 2019) packages. In the study, population, 636 cases (32%) resulted in death, with a higher prevalence in the 60-79 age group, followed by the ≥80 and 30-59 age groups. The most prevalent diseases among deceased and surviving patients with confirmed cases of SARS-CoV-2 infection were those affecting the circulatory system (61.5% vs. 55.5%), the respiratory system (55.8% vs. 26.2%), and the metabolic system (25.9% vs. 25.4%). In patients aged 30-79, respiratory diseases were the primary cause of mortality, whereas in those aged ≥80, circulatory system diseases were more prevalent. Among survivors, cardiovascular diseases were the most common comorbidities across all age groups, followed by respiratory diseases and endocrine, metabolic, and immune disorders. Moreover, these comorbidities were associated with an elevated risk of mortality. The study emphasizes the substantial influence of age and comorbidities on the mortality associated with SARS-CoV-2 infection. These findings highlight the necessity for targeted interventions to manage comorbid conditions in patients with SARS-CoV-2 infection, particularly in older adults.

The Chinese version of the tendency to stigmatize epidemic diseases scale: a translation and validation study

Objective

To translate the Tendency to Stigmatize Epidemics Diseases Scale (TSEDS) into Chinese and to evaluate its psychometric properties.

Methods

Translation and cross-cultural adaptation using the Brislin translation model, and pre-testing to form a Chinese version of TSEDS. A total of 434 adults participated in the study and the TSEDS were measured using the critical ratio method, Pearson correlation analysis, retest reliability, content validity, structural validity, and concurrent validity.

Results

The Chinese version of the TSEDS scale contains 27 items in 5 dimensions, including structural stigma, perceived stigma, organizational stigma, internalized stigma, and social stigma. The average content validity index of the scale was 0.975. The goodness of fit index (χ2/df= 1.981, RMSEA = 0.067, CFI= 0.930, IFI = 0.931, TLI = 0.922) indicated a good model fit. The Cronbach's alpha coefficient was 0.962 and the dimensionality ranged from 0.882 to 0.928. The retest reliability was 0.912.

Conclusion

The Chinese version of TSEDS has good reliability and validity, which can be used to assess the epidemiological stigma tendency of Chinese adults.

90-Day Complication and Readmission Rates for Geriatric Patients With Hip Fracture at Different Time Points From COVID-19 Positivity: A Database Study

INTRODUCTION

Geriatric patients with hip fracture are at risk of having COVID-19 while needing fracture treatment. Understanding the associated risks of variable timing of COVID-19 before surgery may help direct care algorithms.

METHODS

Geriatric patients with documented hip fracture surgery were identified within the PearlDiver M157 database. Patients with a preoperative COVID-19 diagnosis were classified based on time from diagnosis to surgery: ≤ 1 week, > 1 to ≤ 4 weeks, > 4 to ≤ 7 weeks, > 7 to ≤ 10 weeks, and > 10 to ≤ 13 weeks. The association of COVID-19 diagnoses with 90-day complications was evaluated.

RESULTS

Overall, 263,771 patients with hip fracture were identified, of which COVID-19 within 13 weeks of surgery was documented for 976. On multivariable analysis, patients with COVID-19 infection within ≤ 1 week preoperatively demonstrated increased rates of minor adverse events (odds ratio (OR) = 1.50), all adverse events (OR = 1.59), sepsis (OR = 1.70), and pneumonia (OR = 2.35) (P ≤ 0.0007 for each). For time points greater than 1 week, there were no differences in complication rates.

DISCUSSION

Patients with COVID-19 within 1 week of hip fracture surgery demonstrated greater odds of 90-day complications. Reassuringly, patients with COVID-19 diagnoses more than 1 week preoperatively were not associated with increased odds of any assessed complication.

Characteristics and Impact of Long COVID at a Neurology Clinic

INTRODUCTION

Long COVID can also lead to neurological sequelae that affect existing diseases. This study explored how COVID-19 infection affects neurological patients and the relationship between long COVID and exacerbating factors.

METHODS

This retrospective study was conducted on 85 patients with neurological diseases after COVID-19 at the Neurology Department, Inje University Busan Paik Hospital, Korea. The data were collected between August and October 2022. The patients had a medical history, including COVID-19 infection, and completed symptom questionnaires. A long COVID questionnaire consisting of 35 inquiries in 10 categories was completed. Anxiety, depression, fatigue, functional difficulties, QOL, and health status changes were assessed.

RESULTS

The analysis comprised 85 participants (age: 56.4 ± 15.2 years; 63.5% women). Of the categories, neurological symptoms (68.2%) were the most prevalent, followed by systemic symptoms (64.7%) and cardiopulmonary symptoms (56.5%). Anxiety, depression, and fatigue symptoms were reported by 36.5%, 34.1%, and 42.4% of the participants. Subjective neurological deterioration after COVID-19 was reported in 28 participants (28/81, 34.6%). Anxiety, depression, and fatigue were influenced by long COVID symptoms and the subjective deterioration of neurological conditions.

CONCLUSION

This study analyzed the long COVID symptoms in patients with preexisting neurological conditions and their impact on mental health and quality of life. One-third of the participants reported a subjective worsening of their preexisting neurological conditions. This study highlights the need for comprehensive follow-ups and a multidisciplinary approach for patients with neurological conditions and prolonged COVID-19 symptoms.

Natural and socio-environmental factors in the transmission of COVID-19: a comprehensive analysis of epidemiology and mechanisms

PURPOSE OF REVIEW

There are significant differences in the transmission rate and mortality rate of COVID-19 under environmental conditions such as seasons and climates. However, the impact of environmental factors on the role of the COVID-19 pandemic and the transmission mechanism of the SARS-CoV-2 is unclear. Therefore, a comprehensive understanding of the impact of environmental factors on COVID-19 can provide innovative insights for global epidemic prevention and control policies and COVID-19 related research. This review summarizes the evidence of the impact of different natural and social environmental factors on the transmission of COVID-19 through a comprehensive analysis of epidemiology and mechanism research. This will provide innovative inspiration for global epidemic prevention and control policies and provide reference for similar infectious diseases that may emerge in the future.

RECENT FINDINGS

Evidence reveals mechanisms by which natural environmental factors influence the transmission of COVID-19, including (i) virus survival and transport, (ii) immune system damage, (iii) inflammation, oxidative stress, and cell death, and (iiii) increasing risk of complications. All of these measures appear to be effective in controlling the spread or mortality of COVID-19: (1) reducing air pollution levels, (2) rational use of ozone disinfection and medical ozone therapy, (3) rational exposure to sunlight, (4) scientific ventilation and maintenance of indoor temperature and humidity, (5) control of population density, and (6) control of population movement. Our review indicates that with the continuous mutation of SARS-CoV-2, high temperature, high humidity, low air pollution levels, and low population density more likely to slow down the spread of the virus.

Mourning in the time of coronavirus: Examining how grief differs in those who lost loved ones to COVID-19 vs. natural causes in Iran

OBJECTIVES

Our study aimed to analyze and compare the grief experiences of individuals in Iran who lost family members to COVID-19 and those who lost loved ones to other natural causes.

METHODS

In this study, telephone interviews were conducted with 640 first-degree relatives, and finally, a total of 395 people remained in the research. Participants answered the Prolonged Grief Questionnaire (PG-13-R) and Grief Experience Questionnaire.

RESULTS

The results showed that the most common symptoms and features of grief were feeling guilt, searching for an explanation, somatic reactions, and rejection, with no significant difference observed between the 2 death groups. However, the average scores for these symptoms were higher in the COVID-19 death group. Moreover, the majority of bereaved reported signs and symptoms of prolonged grief, with a higher percentage in the COVID-19 death group, although there was no significant difference between the 2 death groups in terms of the distribution of symptoms and signs of prolonged grief. These findings suggest that the bereavement process can be challenging, and losing a loved one to COVID-19 may lead to more intense experiences of grief.

SIGNIFICANCE OF RESULTS

The study reveals high levels of guilt, searching for meaning, somatic reactions, and rejection among COVID-19 grievers. Losing loved ones to the pandemic appears linked to more intense, prolonged grief symptoms.

Effects of the COVID-19 Pandemic on College Students in Brazil

The implementation of restrictive measures during the pandemic drastically changed the routine and habits of the population. In the academic sphere, the sudden closure of universities difficulted any advance planning. The objective of this study was to verify the effects of the pandemic on the routine, physical and mental health of students at a public university in southern Brazil. This is a cross-sectional study that applied a questionnaire from May to August 2020. The target population comprised 528 undergraduates. The questionnaire addressed questions about sociodemographic characteristics, physical and mental health. A response was obtained from 406 participants. During the quarantine period evaluated, the main results were: 66.2% reported worsening of anxiety symptoms; 57.6% declared that their physical health was "reasonable" to "bad". As for the quality of sleep there was an increase in 98.8% in the responses "bad sleep quality" and "very bad sleep quality"; increase in 26.6% for presence bruxism; 12.5% for orofacial pain, 3.8% for headache. It is concluded that there were several negative effects, among these effects, it was observed higher levels of anxiety, worsening physical health and quality of sleep, increase in the prevalence of bruxism, as well as the presence of orofacial pain and headache.

Unmasking the Silent Threat: COVID-19's Pervasive Impact on Renal Allografts

OBJECTIVES

Growing evidence has highlighted the substantial effects of COVID-19 on kidneys, ranging from mild proteinuria to severe acute kidney injury. However, comprehensive assessments of histopathological features in renal allograft biopsies are lacking.

MATERIALS AND METHODS

Seventeen kidney transplant recipients with COVID-19 between March 2020 and November 2022 were evaluated. Clinical characteristics, pathological findings, and outcomes were studied.

RESULTS

Six kidney transplant recipients (35.3%) developed acute kidney injury, leading to the requirement for hemodialysis. COVID-19 severity, as indicated by pneumonia (P = .028) and hospitalization (P = .002), was significantly associated with development of acute kidney injury. Most patients with COVID-19 (82.4%) showed considerably increased proteinuria levels (82.4%), along with presence of new-onset microscopic hematuria (35.3%) and nephrotic syndrome (58.8%). Tubular viral inclusionlike changes were detected in 47.1% of cases and were associated with a higher risk of graft loss (75%). Thrombotic microangiopathy and endothelial cell swelling in glomeruli were prevalent, highlighting extensive endothelial cell injury. Most recipients (88.2%) experienced rejection after COVID-19, with graft loss occurring in 46.7% of these cases. Biopsies revealed collapsing (n = 5), noncollapsing (n = 3), and recurrent (n = 2) focal segmental glomerulosclerosis, as well as acute tubulointerstitial nephritis (n = 3), crescentic glomerulonephritis with immunoglobulin A nephropathy (n = 1), and membranoproliferative glomerulonephritis (n = 1), in 129.7 ± 33 days. Eight patients experienced graft loss (8.2 ± 2 mo posttransplant). Hospitalization (P = .044) and viralinclusion-like nuclear changes in tubules (P = .044) significantly influenced graft survival. Collapsing (60%) and noncollapsing (66.7%) focal segmental glomerulosclerosis increased the risk of graft loss.

CONCLUSIONS

COVID-19 has had a multifaceted and enduring effect on renal allografts, urging the need for meticulous monitoring and tailored management strategies to mitigate the risk of severe kidney-related complications and graft loss in this vulnerable population.

Predictive value of hematocrit, serum albumin level difference, and fibrinogen-to-albumin ratio for COVID-19-associated acute respiratory failure

Background

Acute respiratory failure is the main clinical manifestation and a major cause of death in patients with COVID-19. However, few reports on its prevention and control have been published because of the need for laboratory predictive indicators. This study aimed to evaluate the predictive value of hematocrit level, serum albumin level difference, and fibrinogen-to-albumin ratio for COVID-19-associated acute respiratory failure.

Material and methods

A total of 120 patients with COVID-19 from the First Affiliated Hospital of Anhui Medical University were selected between December 2022 and March 2023. Patients were divided into acute respiratory failure and non-acute respiratory failure groups and compared patient-related indicators between them using univariate and multivariate logistic regression analyses. Receiver operating characteristic analysis was performed to determine the discrimination accuracy.

Results

In total, 48 and 72 patients were enrolled in the acute respiratory failure and non-acute respiratory failure groups, respectively. The Quick COVID-19 Severity Index scores, fibrinogen-to-albumin ratio, hematocrit and serum albumin level difference, fibrinogen, and hematocrit levels were significantly higher in the acute respiratory failure group than in the non-acute respiratory failure group. A Quick COVID-19 Severity Index >7, fibrinogen-to-albumin ratio >0.265, and hematocrit and serum albumin level difference >12.792 had a 96.14 % positive predictive rate and a 94.06 % negative predictive rate.

Conclusion

Both fibrinogen-to-albumin ratio and hematocrit and serum albumin level difference are risk factors for COVID-19-associated acute respiratory failure. The Quick COVID-19 Severity Index score combined with fibrinogen-to-albumin ratio, and hematocrit and serum albumin level difference predict high and low risks with better efficacy and sensitivity than those of the Quick COVID-19 Severity Index score alone; therefore, these parameters can be used collectively as a risk stratification method for assessing patients with COVID-19.

Platelet Indices as Novel Surrogate Markers for the Prognosis of COVID-19 Infection: An Observational Study

Background  The new severe acute respiratory syndromecoronavirus 2 (SARS-CoV-2) causes severe acute respiratory illness accountable for causing the coronavirus disease 2019 (COVID-19) illness. Thrombotic issues, acute respiratory distress syndrome (ARDS), and cytokine storm are significant contributors to morbidity and mortality in patients with COVID-19. Elevated D-dimer levels and prothrombin times are further indicators of abnormal coagulation parameters in COVID-19 patients. This study aimed to study the platelet indices as prognostic markers in COVID-19 infection. Methods In this prospective observational study, 150 real-time reverse transcription-polymerase chain reaction (RT-PCR)-positive COVID-19 patients were enrolled between October 2020 and September 2021. All the subjects were screened and explained the study procedure in their native language. Following enrolment, a detailed history and physical examination were performed. Subsequently, laboratory investigations were performed, and patients were subjected to high-resolution computed tomography (HRCT) examination to classify patients into mild, moderate, and severe according to the severity of the illness. The platelet indices taken into account were plateletcrit (PCT) in percentage, platelet count (PLT) in lakh per microlitre, mean platelet volume (MPV) in femtolitres, and platelet distribution width (PDW) in femtolitres. Results The mean PLT was significantly greater among survivors than non-survivors (2.03 ± 0.72 versus 1.76 ± 0.47; p-value = 0.018). The mean MPV (10.42 ± 0.53 versus 9.22 ± 0.64; p-value <0.0001) and PDW (17.99 ± 1.53 versus 16.54 ± 0.91 fl; p-value <0.0001) were significantly greater among non-survivors than survivors. However, the mean PCT was significantly greater among survivors than non-survivors (0.22 ± 0.03% versus 0.18 ± 0.33%; p-value <0.0001). At a cut-off of 0.213, the sensitivity and specificity of PCT in predicting death were found to be 79.2% and 74.5%, respectively. At a cut-off of 16.75, the sensitivity and specificity of PDW in predicting death were found to be 68.8% and 59.8%, respectively. The findings demonstrated a relationship between elevated MPV and PDW and mortality and severe COVID-19 infection. Increased PCT was connected to higher survival, with a specificity and sensitivity of 87.5% and 75.5%, respectively, and MPV >9.75 may predict death. PDW >16.75 exhibited a specificity and sensitivity of 68.8% and 59.8%, respectively, in predicting death. With comparable sensitivity and specificity of 79.2% and 74.5%, PCT >0.213 may predict death. Conclusion In severely sick COVID-19 patients, platelet indices should be routinely calculated and can be utilized as simple, low-cost prognostic indicators.

Understanding the impact of chronic diseases on COVID-19 vaccine hesitancy using propensity score matching: Internet-based cross-sectional study

AIMS AND OBJECTIVES

To investigate whether chronic diseases are associated with higher COVID-19 vaccine hesitancy and explore factors that influence COVID-19 vaccine hesitancy in patients with chronic diseases.

BACKGROUND

Vaccine hesitancy has been acknowledged as one of the greatest hazards to public health. However, little information is available about COVID-19 vaccine hesitancy among patients with chronic diseases who may be more susceptible to COVID-19 infection, severe disease or death.

METHODS

From 6 to 9 August 2021, we performed an internet-based cross-sectional survey with 22,954 participants (14.78% participants with chronic diseases). Propensity score matching with 1:1 nearest neighbourhood was used to reduce confounding factors between patients with chronic diseases and the general population. Using a multivariable logistic regression model, the factors impacting COVID-19 vaccine hesitancy were identified among patients with chronic diseases.

RESULTS

Both before and after propensity score matching, patients with chronic diseases had higher COVID-19 vaccine hesitancy than the general population. In addition, self-reported poor health, multiple chronic diseases, lower sociodemographic backgrounds and lower trust in nurses and doctors were associated with COVID-19 vaccine hesitancy among patients with chronic diseases.

CONCLUSIONS

Patients with chronic diseases were more hesitant about the COVID-19 vaccine. Nurses should focus on patients with chronic diseases with poor health conditions, low socioeconomic backgrounds and low trust in the healthcare system.

RELEVANCE TO CLINICAL PRACTICE

Clinical nurses are recommended to not only pay more attention to the health status and sociodemographic characteristics of patients with chronic diseases but also build trust between nurses and patients by improving service levels and professional capabilities in clinical practice.

PATIENT OR PUBLIC CONTRIBUTION

Patients or the public were not involved in setting the research question, the outcome measures, or the design or implementation of the study. However, all participants were invited to complete the digital informed consent and questionnaires.

Physiotherapy services during the COVID-19 pandemic: A mediated model of physiotherapists' self-efficacy, tele-physiotherapy role stressors, and motivation to provide tele-physiotherapy

BACKGROUND

Occupational self-efficacy is a stable predictor for professionals' motivation to engage with new methods and tasks. Yet, the delivery of tele-physiotherapy (Tele-PT) by physiotherapists (PTs) during the coronavirus disease of 2019 (COVID-19) outbreak without advance training may have had the potential to increase work stress and damage their motivation, regardless of their occupational self-efficacy.

OBJECTIVES

The present study examined whether the relations between PTs' overall occupational self-efficacy and motivation to provide Tele-PT was mediated by role stress (i.e. role conflict and ambiguity).

DESIGN AND METHOD

Between February 4 and April 23, 2021, 150 Israeli PTs completed an online survey that measured their overall occupational self-efficacy, their role stress induced by the provision of Tele-PT, their motivation to provide Tele-PT, and their demographic characteristics.

RESULTS

PTs' overall occupational self-efficacy was positively associated with PTs' motivation to provide Tele-PT (r= 0.328, p < .01) and fully mediated by role conflict (0.1757, 95% CI = [0.0231, 0.3797]) and by role ambiguity (0.1845, 95% CI = [0.0196, 0.4184]) (components of role stress) caused by the provision of Tele-PT.

CONCLUSIONS

It is important to investigate the predictors and mediators of the motivation to provide Tele-PT because in the post-COVID-19 era health organizations are likely to adopt many tele-medicine services, and they need to find ways to mitigate perceived challenges.

SARS-CoV-2 vaccine breakthrough infection and the evaluation of safety precaution practice before and after vaccination among healthcare workers in South West, Nigeria

INTRODUCTION

Worldwide, it has been reported that fully vaccinated people still die of COVID-19-associated symptoms, generating public uncertainty about the safety and effectiveness of the vaccines. Hence, this research is aimed at assessing the incidence of COVID-19 breakthrough infection among vaccinated Health Workers and the possible effect of changes in the practice of post-vaccination safety precautions.

METHOD

This was a Health facility-based descriptive cross-sectional study. Data were collected using self-administered questionnaires distributed at the participant's work unit across the selected health facilities. The nasopharyngeal specimen was also obtained from the participants and analysed using STANDARD Q COVID-19 Ag Test rapid chromatographic immunoassay for the detection of antigens to SARS-CoV-2. All data were input and analyzed using SPSS version 20.

RESULTS

There was a statistically significant relationship between the vaccination status of respondents and the post-vaccination test result (χ2 = 6.816, df = 1, p = 0.009). The incidence of COVID-19 infection among the vaccinated and unvaccinated HCWs was 2% and 8% respectively. 5 of the 15 respondents who tested positive for COVID-19 had been fully vaccinated. However, all 5 of them did not practice safety measures after vaccination. None of the respondents who practised safety measures after vaccination tested positive for COVID-19. The remaining 10 respondents that tested positive for COVID-19 had not been vaccinated though they practised safety precautions.

CONCLUSION

Vaccination and the practice of safety precautions will go a long way to preventing future COVID-19 breakthrough infections.

Association between receiving Covid-19 vaccine and menstrual cycle patterns among childbearing women: A cross-sectional study

Background and Aims

Many women reported experiencing abnormalities in their cycle after being vaccinated with Covid-19 vaccination. To understand this issue further, our study aimed to evaluate the menstrual cycle patterns among women of childbearing age after receiving COVID-19 vaccinations.

Methods

A cross-sectional study was conducted to investigate the impact of COVID-19 vaccine on women aged 18 years and above in Saudi Arabia. A self-administered online questionnaire was distributed among participants who had received at least one dose of COVID-19 vaccine. The questionnaire included questions about the participants' demographic characteristics, medical history, and vaccine-related adverse events.

Results

The study included 383 female participants with an average age of 30.8 ± 8.1 years. The majority of participants, 92.7%, were Saudi, and more than half, 51.4%, were single. Of the participants, 78.9% were disease-free, and a majority of 67.9% had no history of Coronavirus Disease 2019 infection. A significant proportion of participants reported postvaccination changes in the menstrual cycle. Specifically, 43.1% reported changes after the first dose, and 38.4% reported changes after the second dose (p = 0.044). The severity of premenstrual symptoms increased from 44 (11.5%) to 113 (29.5%) after the first dose. Reported pain on the (WONG-BAKER) scale was also significantly elevated from 34 (8.9%) to 87 (22.7%) (p < 0.001) after the first dose.

Conclusion

A relatively high prevalence of menstrual cycle irregularities was reported by Saudi vaccinated women, particularly young adults. These findings suggest the need to further research and explore the underlying causes of these irregularities and develop interventions that may help mitigate their impact on women's health. It is also recommended that women who observe long-term changes in their menstrual cycles seek follow-up and consultation with healthcare providers to ensure that any potential health concerns are addressed promptly.

Listening to patients, for the patients: The COVAD Study-Vision, organizational structure, and challenges

BACKGROUND

The pandemic presented unique challenges for individuals with autoimmune and rheumatic diseases (AIRDs) due to their underlying condition, the effects of immunosuppressive treatments, and increased vaccine hesitancy.

OBJECTIVES

The COVID-19 vaccination in autoimmune diseases (COVAD) study, a series of ongoing, patient self-reported surveys were conceived with the vision of being a unique tool to gather patient perspectives on AIRDs. It involved a multinational, multicenter collaborative effort amidst a global lockdown.

METHODS

Leveraging social media as a research tool, COVAD collected data using validated patient-reported outcomes (PROs). The study, comprising a core team, steering committee, and global collaborators, facilitated data collection and analysis. A pilot-tested, validated survey, featuring questions regarding COVID-19 infection, vaccination and outcomes, patient demographics, and PROs was circulated to patients with AIRDs and healthy controls (HCs).

DISCUSSION

We present the challenges encountered during this international collaborative project, including coordination, data management, funding constraints, language barriers, and authorship concerns, while highlighting the measures taken to address them.

CONCLUSION

Collaborative virtual models offer a dynamic new frontier in medical research and are vital to studying rare diseases. The COVAD study demonstrates the potential of online platforms for conducting large-scale, patient-focused research and underscores the importance of integrating patient perspective into clinical care. Care of patients is our central motivation, and it is essential to recognize their voices as equal stakeholders and valued partners in the study of the conditions that affect them.

Using SCENTinel® to predict SARS-CoV-2 infection: insights from a community sample during dominance of Delta and Omicron variants

Introduction

Based on a large body of previous research suggesting that smell loss was a predictor of COVID-19, we investigated the ability of SCENTinel®, a newly validated rapid olfactory test that assesses odor detection, intensity, and identification, to predict SARS-CoV-2 infection in a community sample.

Methods

Between April 5, 2021, and July 5, 2022, 1,979 individuals took one SCENTinel® test, completed at least one physician-ordered SARS-CoV-2 PCR test, and endorsed a list of self-reported symptoms.

Results

Among the of SCENTinel® subtests, the self-rated odor intensity score, especially when dichotomized using a previously established threshold, was the strongest predictor of SARS-CoV-2 infection. SCENTinel® had high specificity and negative predictive value, indicating that those who passed SCENTinel® likely did not have a SARS-CoV-2 infection. Predictability of the SCENTinel® performance was stronger when the SARS-CoV-2 Delta variant was dominant rather than when the SARS-CoV-2 Omicron variant was dominant. Additionally, SCENTinel® predicted SARS-CoV-2 positivity better than using a self-reported symptom checklist alone.

Discussion

These results indicate that SCENTinel® is a rapid assessment tool that can be used for population-level screening to monitor abrupt changes in olfactory function, and to evaluate spread of viral infections like SARS-CoV-2 that often have smell loss as a symptom.

A conceptional model integrating geographic information systems (GIS) and social media data for disease exposure assessment

Although previous studies have acknowledged the potential of geographic information systems (GIS) and social media data (SMD) in assessment of exposure to various environmental risks, none has presented a simple, effective and user-friendly tool. This study introduces a conceptual model that integrates individual mobility patterns extracted from social media, with the geographic footprints of infectious diseases and other environmental agents utilizing GIS. The efficacy of the model was independently evaluated for selected case studies involving lead in the ground; particulate matter in the air; and an infectious, viral disease (COVID- 19). A graphical user interface (GUI) was developed as the final output of this study. Overall, the evaluation of the model demonstrated feasibility in successfully extracting individual mobility patterns, identifying potential exposure sites and quantifying the frequency and magnitude of exposure. Importantly, the novelty of the developed model lies not merely in its efficiency in integrating GIS and SMD for exposure assessment, but also in considering the practical requirements of health practitioners. Although the conceptual model, developed together with its associated GUI, presents a promising and practical approach to assessment of the exposure to environmental risks discussed here, its applicability, versatility and efficacy extends beyond the case studies presented in this study.

The impact of comorbidities and economic inequality on COVID-19 mortality in Mexico: a machine learning approach

Introduction

Studies from different parts of the world have shown that some comorbidities are associated with fatal cases of COVID-19. However, the prevalence rates of comorbidities are different around the world, therefore, their contribution to COVID-19 mortality is different. Socioeconomic factors may influence the prevalence of comorbidities; therefore, they may also influence COVID-19 mortality.

Methods

This study conducted feature analysis using two supervised machine learning classification algorithms, Random Forest and XGBoost, to examine the comorbidities and level of economic inequalities associated with fatal cases of COVID-19 in Mexico. The dataset used was collected by the National Epidemiology Center from February 2020 to November 2022, and includes more than 20 million observations and 40 variables describing the characteristics of the individuals who underwent COVID-19 testing or treatment. In addition, socioeconomic inequalities were measured using the normalized marginalization index calculated by the National Population Council and the deprivation index calculated by NASA.

Results

The analysis shows that diabetes and hypertension were the main comorbidities defining the mortality of COVID-19, furthermore, socioeconomic inequalities were also important characteristics defining the mortality. Similar features were found with Random Forest and XGBoost.

Discussion

It is imperative to implement programs aimed at reducing inequalities as well as preventable comorbidities to make the population more resilient to future pandemics. The results apply to regions or countries with similar levels of inequality or comorbidity prevalence.

Four Years Since COVID-19 Day Zero: A Time to Evaluate Past and Future Pandemic Control Policies and Practices in Sub-Saharan Africa?

Four years after the first case of COVID-19, the world is still determining how best to prevent and control the long-term effects of SARS-CoV-2 infection. Non-pharmaceutical interventions (NPIs) were employed at the start of the pandemic as the only available options, prior to effective vaccines and antiviral agents. The World Health Organization recommended dual vaccination for 70% worldwide as the threshold for a return to "normal" community life. Immunization rates needed to increase in all global regions, irrespective of socioeconomic status, necessitating more equitable access. During the pandemic, wealthier countries hoarded vaccine supplies even when their citizens were immunized. This highlights the already enormous difficulties in healthcare provision faced by low-income sub-Saharan African countries, which remain at risk as industrialized nations have progressed to a post-pandemic era. Thus, in addition to redoubling vaccination efforts public health policymakers should consider ongoing and future use of NPIs. In this narrative account, we advocate that various NPI practices should not be shelved; rather, more research is needed to evaluate their impact in parallel with booster vaccination. This especially applies to so-called "long COVID". Lessons learned from implementing best practices in resource-limited settings should be incorporated into preparedness guidelines for future infectious disease outbreaks.

Use of Hydrogen Peroxide Vapour for Microbiological Disinfection in Hospital Environments: A Review

Disinfection of nosocomial pathogens in hospitals is crucial to combat healthcare-acquired infections, which can be acquired by patients, visitors and healthcare workers. However, the presence of a wide range of pathogens and biofilms, combined with the indiscriminate use of antibiotics, presents infection control teams in healthcare facilities with ongoing challenges in the selection of biocides and application methods. This necessitates the development of biocides and innovative disinfection methods that overcome the shortcomings of conventional methods. This comprehensive review finds the use of hydrogen peroxide vapour to be a superior alternative to conventional methods. Motivated by observations in previous studies, herein, we provide a comprehensive overview on the utilisation of hydrogen peroxide vapour as a superior high-level disinfection alternative in hospital settings. This review finds hydrogen peroxide vapour to be very close to an ideal disinfectant due to its proven efficacy against a wide range of microorganisms, safety to use, lack of toxicity concerns and good material compatibility. The superiority of hydrogen peroxide vapour was recently demonstrated in the case of decontamination of N95/FFP2 masks for reuse to address the critical shortage caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the COVID-19 pandemic. Despite the significant number of studies demonstrating antimicrobial activity, there remains a need to critically understand the mechanism of action by performing studies that simultaneously measure damage to all bacterial cell components and assess the correlation of this damage with a reduction in viable cell count. This can lead to improvement in antimicrobial efficacy and foster the development of superior approaches.

Understanding exosomes: Part 2-Emerging leaders in regenerative medicine

Exosomes are the smallest subset of extracellular signaling vesicles secreted by most cells with the ability to communicate with other tissues and cell types over long distances. Their use in regenerative medicine has gained tremendous momentum recently due to their ability to be utilized as therapeutic options for a wide array of diseases/conditions. Over 5000 publications are currently being published yearly on this topic, and this number is only expected to dramatically increase as novel therapeutic strategies continue to be developed. Today exosomes have been applied in numerous contexts including neurodegenerative disorders (Alzheimer's disease, central nervous system, depression, multiple sclerosis, Parkinson's disease, post-traumatic stress disorders, traumatic brain injury, peripheral nerve injury), damaged organs (heart, kidney, liver, stroke, myocardial infarctions, myocardial infarctions, ovaries), degenerative processes (atherosclerosis, diabetes, hematology disorders, musculoskeletal degeneration, osteoradionecrosis, respiratory disease), infectious diseases (COVID-19, hepatitis), regenerative procedures (antiaging, bone regeneration, cartilage/joint regeneration, osteoarthritis, cutaneous wounds, dental regeneration, dermatology/skin regeneration, erectile dysfunction, hair regrowth, intervertebral disc repair, spinal cord injury, vascular regeneration), and cancer therapy (breast, colorectal, gastric cancer and osteosarcomas), immune function (allergy, autoimmune disorders, immune regulation, inflammatory diseases, lupus, rheumatoid arthritis). This scoping review is a first of its kind aimed at summarizing the extensive regenerative potential of exosomes over a broad range of diseases and disorders.

Relationships between racial discrimination, social isolation, and mental health among international Asian graduate students during the COVID-19 pandemic

Objectives: Racial aggression against Asians and the implementation of state-wide stay-at-home orders during the COVID-19 pandemic may have negatively impacted mental health in Asian international graduate students in the United States, yet these relationships are unknown. Therefore, this study was conducted to investigate these relationships. Participants: Data were collected from 177 participants from four universities. Methods: On-line survey was used to assess perceived racial discrimination related to the COVID-19, daily racial discrimination during the pandemic, home boundness and loneliness, and depression and anxiety. Results: Daily racial discrimination was associated with an increased risk for depression. Home boundness was related to fewer depression symptoms (B = -0.728) and fewer anxiety symptoms (B = -0.558). Higher symptoms of loneliness (B = 0.377) were related to more depression symptoms. More loneliness (B = 0.257) was related to more anxiety symptoms. Conclusions: The findings can help university stakeholders to create a guideline for the development and implementation of resource programs for Asian international graduates.

Silent battles: immune responses in asymptomatic SARS-CoV-2 infection

SARS-CoV-2 infections manifest with a broad spectrum of presentations, ranging from asymptomatic infections to severe pneumonia and fatal outcomes. This review centers on asymptomatic infections, a widely reported phenomenon that has substantially contributed to the rapid spread of the pandemic. In such asymptomatic infections, we focus on the role of innate, humoral, and cellular immunity. Notably, asymptomatic infections are characterized by an early and robust innate immune response, particularly a swift type 1 IFN reaction, alongside a rapid and broad induction of SARS-CoV-2-specific T cells. Often, antibody levels tend to be lower or undetectable after asymptomatic infections, suggesting that the rapid control of viral replication by innate and cellular responses might impede the full triggering of humoral immunity. Even if antibody levels are present in the early convalescent phase, they wane rapidly below serological detection limits, particularly following asymptomatic infection. Consequently, prevalence studies reliant solely on serological assays likely underestimate the extent of community exposure to the virus.

The interplay between Sars-Cov-2 infection related cardiovascular diseases and depression. Common mechanisms, shared symptoms

In 2020 the World Health organization announced a pandemic due to the outbreak of the Coronavirus disease 19. Pneumonia was the most common manifestation of the Sars-Cov-2 infection, however, clinical papers describe Sars-Cov-2 associated cardiovascular pathologies, such as ACS, myopericarditis, cardiomyopathies, dysrhythmias, as leading causes of increased morbidity and mortality. The short and long term prognosis of Sars-Cov-2-related cardiovascular diseases was defined not only by the disease severity itself but also by associated conditions and complications, among which mental health issues (stress, depression and anxiety) have a negative impact. The interplay between Sars-Cov-2 infection, cardiovascular disease and depression may be explained by hyperinflammation, unhealthy lifestyle and inter-organ communication, mediated by extracellular vesicles (EV) and non-coding MicroRNA (miRNA). The long Covid syndrome is characterized with orthostatic hypotension, impaired cardiac and cerebral perfusion, postural orthostatic tachycardia syndrome (POTS), syncope, chest pain, dyspnea, palpitation, chronic fatigue syndrome, 'brain fog', memory, cognitive and sleep difficulties, depression and anxiety. From a clinical point of view these symptoms may be considered as common symptoms representing not only a cardiac but also a neurological/psychiatric problem. Consequently assessment of these symptoms are of paramount importance. Due to their complexity, management of these patients requires multidisciplinary care.