Coronavirus: Why Men are More Vulnerable to Covid-19 Than Women?

Protection and waning of vaccine-induced, natural and hybrid immunity to SARS-CoV-2 in Hong Kong

BACKGROUND

As the COVID-19 pandemic transitions into its fourth year, understanding the dynamics of immunity is critical for implementing effective public health measures. This study examines vaccine-induced, natural, and hybrid immunity to SARS-CoV-2 in Hong Kong, focusing on their protective effectiveness and waning characteristics against infection during the Omicron BA.1/2 dominant period.

RESEARCH DESIGN AND METHODS

We conducted a territory-wide retrospective cohort study using vaccination and infection records from the Hong Kong Department of Health. The analysis included over 6.5 million adults, applying the Andersen-Gill model to estimate protective effectiveness while addressing selection bias through inverse probability weighting.

RESULTS

Vaccine-induced immunity peaked one month after the first dose but waned rapidly, while boosters significantly prolonged protection. Infection-induced immunity showed higher initial effectiveness but declined faster than vaccine-induced immunity. Hybrid immunity provided the most durable protection. mRNA vaccines (Comirnaty) demonstrated greater effectiveness and slower waning compared to inactivated vaccines (CoronaVac).

CONCLUSIONS

Hybrid immunity represents the most effective strategy for sustained protection against SARS-CoV-2. Public health policies should emphasize booster campaigns and hybrid immunity pathways to enhance population-level immunity and guide future COVID-19 management in Hong Kong.

Infoveillance of COVID-19 Infections in Dentistry Using Platform X: Descriptive Study

BACKGROUND

The effect of the COVID-19 pandemic on the well-being of dental professionals and patients has been difficult to track and quantify. X (formerly known as Twitter) proved to be a useful infoveillance tool for tracing the impact of the COVID-19 pandemic worldwide.

OBJECTIVE

This study aims to investigate the use of X to track COVID-19 infections and deaths associated with dental practices.

METHODS

English Tweets reporting infections or deaths associated with the dental practice were collected from January 1, 2020, to March 31, 2021. Tweets were searched manually using the X Pro search engine (previously known as TweetDeck [X Corp], Twitter Inc, and TweetDeck Ltd) and automatically using a tweet crawler on the X Academic Research application programming interface. Queries included keywords on infection or death of dental staff and patients caused by COVID-19. Tweets registering events on infection or death of dentists, dental staff, and patients as part of their conversation were included.

RESULTS

A total of 5641 eligible tweets were retrieved. Of which 1583 (28.1%) were deemed relevant after applying the inclusion and exclusion criteria. Of the relevant tweets, 311 (19.6%) described infections at dental practices, where 1168 (86.9%) infection cases were reported among dentists, 134 (9.9%) dental staff, and 41 (3.1%) patients. The majority of reported infections occurred in the United States, India, and Canada, affecting individuals aged 20-51 years. Among the 600 documented deaths, 253 (42.2%) were dentists, 22 (3.7%) were dental staff, and 7 (1.2%) were patients. The countries with the highest number of deaths were the United States, Pakistan, and India, with an affected age range of 23-83 years.

CONCLUSIONS

The data suggest that analyses of X information in populations of affected areas may provide useful information regarding the impact of a pandemic on the dental profession and demonstrate a correlation with suspected and confirmed infection or death cases. Platform X shows potential as an early predictor for disease spread. However, further research is required to confirm its validity.

Estimation of trajectory of COVID-19 vaccines effectiveness against infection

This large-scale cohort study conducted in Hong Kong examined the time-varying protective effects of various COVID-19 vaccines and dosing regimens against the Omicron BA.1/BA.2 variants. An innovative pharmacokinetic/pharmacodynamic model was employed to estimate the trajectory of vaccine effectiveness over time. Results indicated that the maximum protection for a single dose reached 0.120 for CoronaVac and 0.171 for Comirnaty. The peak protective effectiveness for the second and third doses were observed at 0.348 and 0.522, respectively. In a 4-dose regimen, CoronaVac demonstrated a maximum protective effectiveness of 0.548, stabilizing at 0.487, while Comirnaty achieved a maximum effectiveness of 0.784, stabilizing at 0.714 six months after the administration of the last dose. The vaccine effectiveness exhibited a rising and then declining pattern, peaking approximately 1-2 months post-vaccination. Understanding waning immunity is crucial for optimizing vaccination strategies and policies as viral evolution continues. This real-world study captured changing dynamics that may differ from clinical trials with limited follow-up, providing essential evidence to guide the optimization of vaccination efforts. Ongoing monitoring of vaccine effectiveness remains critical as the viral landscape evolves.

OBJECTIVES

This study aims to investigate the time-varying protective effects of various COVID-19 vaccines and dosing regimens against infections caused by the Omicron BA.1/BA.2 in Hong Kong.

METHODS

This territory-wide cohort study from Hong Kong combined vaccination records, confirmed COVID-19 cases, and census data from January 2022 to May 2022 to comprehensively analyze the time-varying protective effects of different COVID-19 vaccines and dosing regimens against Omicron BA.1 and BA.2 infections. A 4-parameter pharmacokinetic/pharmacodynamic model was used to estimate the trajectory of vaccine effectiveness over time.

RESULTS

Among 6.2 million adults, the maximum protective effectiveness for a single vaccine dose reached 0.120 for CoronaVac and 0.171 for Comirnaty. For the second and third doses, peak effectiveness were observed at 0.348 for CoronaVac and 0.522 for Comirnaty. Notably, a 4-dose regimen resulted in maximum protections of 0.548 for CoronaVac and 0.785 for Comirnaty, which stabilized at 0.487 and 0.714, respectively, six months following the last doses. The vaccine effectiveness exhibited a rising then declining pattern, peaking around 1-2 months post-vaccination, underscoring the importance of ongoing vaccination strategies.

CONCLUSIONS

Understanding the waning of vaccine protection over time is critical for informing optimal vaccination strategies, booster schedules, and public health policies. This real-world study can capture changing dynamics that may differ from clinical trials which have more limited follow-up periods, and can provide crucial evidence to guide optimization of vaccination strategies. Ongoing monitoring of vaccine effectiveness remains crucial as the viral evolution continues.

Female versus viral: Understanding the UK gender health inequalities during the Covid-19 pandemic using e-archives

Despite the development of digital health infrastructure, female health inequalities have worsened during the pandemic. This transdisciplinary study, through health, feminist, and infrastructural geographical lens, examines how gender health inequalities may have emerged or worsened during Covid-19 in the UK. This study leverages a novel web archive collection, Python coding-powered data-handling text analysis (of over 0.2 billion words), and thematic analysis to examine three themes: vaccines, social minority groups, and women's self-care. The findings suggest that the pandemic has impacted health inequalities among British women and girls and more, in a 'more-than-gender' way in terms of health (care) outcomes and access. In addition to reflecting on the use of e-archives in this study including suggesting the potential of combining e-archiving, coding, natural language processing (NLP) and generative AI/Large Language Models (LLMs) in producing and analysing trans-temporal (big) datasets, I argue that a geographical crisis perspective that balances the needs of everyday life and possible crises can be considered when preparing for public health emergencies. I adopt the e-archiving of this study to rethink 'digital health infrastructure' as 'actors', 'facilitators', and 'voicers', revealing how human-computer interaction and people in the virtual realm can be infrastructure.

Clinical aspects and characterization of Pseudomonas aeruginosa isolated from patients infected with SARS-CoV-2

AIMS

This study aimed to identify and characterize Pseudomonas aeruginosa isolates from patients infected and uninfected with SARS-CoV-2, focusing on their phenotypic characteristics and antimicrobial resistance profiles.

MAIN METHODS

A total of 100 P. aeruginosa isolates were obtained from patients admitted to a hospital in Presidente Prudente, SP, in 2021. The isolates were assessed for antimicrobial resistance, pyocyanin, lipase and phospholipase C production, biofilm formation, and the presence of virulence factor genes, including those associated with metallo-β-lactamase (MBL) production.

KEY FINDINGS

Among the isolates, 58 were from patients infected with SARS-CoV-2 and 42 from non-infected patients. P. aeruginosa was predominantly isolated from tracheal secretion samples in infected patients, while urine samples were more common in non-infected patients. Notably, patients with SARS-CoV-2 exhibited a higher rate of resistance to aztreonam and used a wider range of antibiotics. Isolates from infected patients demonstrated higher phospholipase C production and a greater number classified as strong biofilm formers. Virulence factor genes were present in at least 70 % of the isolates, while only three isolates showed genes for MBL production.

SIGNIFICANCE

The findings of this study indicate that the COVID-19 pandemic creates a favorable environment for the increase of secondary infections by P. aeruginosa. Understanding the characteristics and resistance profiles of these isolates is crucial for improving treatment strategies and patient outcomes.

Predicting COVID-19 Patient Disposition Using the National Early Warning Score 2: A Retrospective Cohort Study

Objectives To evaluate the effectiveness of the National Early Warning Score 2 (NEWS2) in predicting the need for hospital admission and close monitoring of suspected patients with COVID-19 presenting to the Emergency Department (ED). This study aims to determine whether NEWS2 can aid in identifying high-risk patients with COVID-19 requiring urgent care and admission. Methodology Retrospective data from electronic health records of 300 patients with COVID-19 who presented to Mediclinic Parkview Hospital ED between January 1, 2021, and June 30, 2021, were analyzed. Collected variables included age, gender, body mass index (BMI), vital signs, and patient disposition. Statistical analysis was conducted to assess the ability of NEWS2 to predict COVID-19 patient disposition. Results A total of 300 patients were included, and their NEWS2 scores were analyzed to predict clinical deterioration. NEWS2, with a cutoff value of 2, predicted hospital admission with 86% sensitivity and 75% specificity. It achieved an average area under the curve (AUC) of 0.86 for predicting outcomes at 24 to 72 hours from the time of initial presentation to the ED. Conclusions NEWS2 demonstrates high sensitivity in predicting the disposition of patients with COVID-19. Our findings support the use of NEWS2 as a useful tool for the initial assessment of patients with COVID-19 presenting to the ED, assisting in identifying patients at risk of deterioration.

Effectiveness of Frequent Point-of-Care Molecular COVID-19 Surveillance in a Rural Workplace: Nonrandomized Controlled Clinical Trial Among Miners

Background

Numerous studies have assessed the risk of SARS-CoV-2 exposure and infection among health care workers during the pandemic. However, far fewer studies have investigated the impact of SARS-CoV-2 on essential workers in other sectors. Moreover, guidance for maintaining a safely operating workplace in sectors outside of health care remains limited. Workplace surveillance has been recommended by the Centers for Disease Control and Prevention, but few studies have examined the feasibility or effectiveness of this approach.

Objective

The objective of this study was to investigate the feasibility and effectiveness of using frequent point-of-care molecular workplace surveillance as an intervention strategy to prevent the spread of SARS-CoV-2 at essential rural workplaces (mining sites) where physical distancing, remote work, and flexible schedules are not possible.

Methods

In this nonrandomized controlled clinical trial conducted from February 2021, to March 2022, 169 miners in New Mexico (intervention cohort) and 61 miners in Wyoming (control cohort) were enrolled. Investigators performed point-of-care rapid antigen testing on midnasal swabs (NSs) self-collected by intervention miners. Our first outcome was the intervention acceptance rate in the intervention cohort. Our second outcome was the rate of cumulative postbaseline seropositivity to SARS-CoV-2 nucleocapsid protein, which was analyzed in the intervention cohort and compared to the control cohort between baseline and 12 months. The diagnostic accuracy of detecting SARS-CoV-2 using rapid antigen testing on NSs was compared to laboratory-based reverse transcriptase polymerase chain reaction (RT-PCR) on nasopharyngeal swabs (NPSs) in a subset of 68 samples.

Results

Our intervention had a mean acceptance rate of 96.4% (11,413/11,842). The intervention miners exhibited a lower cumulative postbaseline incident seropositivity at 12 months compared to control miners (14/97, 14% vs 17/45, 38%; P=.002). Analysis of SARS-CoV-2 antigen detection in self-administered NSs revealed 100% sensitivity and specificity compared to laboratory-based RT-PCR testing on NPSs.

Conclusions

Our findings establish frequent point-of-care molecular workplace COVID-19 surveillance as a feasible option for keeping essential rural workplaces open and preventing SARS-CoV-2 spread. These findings extend beyond this study, providing valuable insights for designing interventions to maintain employees' safety at other essential workplaces during an infectious disease outbreak.

Exploring the Relationship Between Humoral and Cellular T Cell Responses Against SARS-CoV-2 in Exposed Individuals From Emilia Romagna Region and COVID-19 Severity

COVID-19 remains a significant global health problem with uncertain long-term consequences for convalescents. We investigated the relationships between anti-N protein antibody levels, severe acute respiratory syndrome (SARS)-CoV-2-associated TCR repertoire parameters, HLA type and epidemiological information from three cohorts of 524 SARS-CoV-2-infected subjects subgrouped in acute phase, seronegative and seropositive convalescents from the Emilia Romagna region. Epidemiological information and anti-N antibody index were associated with TCR repertoire data. HLA type was inferred from TCR repertoire using the HLA3 tool and its association with clonal breadth (CB) and clonal depth (CD) was assessed. Age above 58 years, male and COVID-19 hospitalisation were significantly and independently associated with seropositivity (p = 0.004; p = 0.004; p = 0.04), suggesting an association between high antibody titres and symptoms' severity. As for the TCR repertoire analysis, we found no difference in CB among the cohorts, while CD was higher in seronegative than acute (p = 0.04). However, clustering analysis supported that seronegative patients are endowed with broader CB and deeper CD indicating a compensatory mechanism without effective seroconversion. The CD calculated on the TCRs associated with the single SARS-CoV-2 ORFs in convalescents is higher when compared to the acute. Lastly, we identified and reported on novel HLAs significantly associated with increased risk of hospitalisation such as HLA-C*07:02 carriers (OR = 3.9, CI = 1.1-13.4, p = 0.03) and on HLAs that associate significantly with lower or higher TCR repertoire parameters in a population exposed for the first time to SARS-CoV-2.

Retrospective study of factors associated with the clinical severity of covid-19 in older adults in Minas Gerais: structural equation modeling

BACKGROUND

Studies have shown an association between the clinical severity of coronavirus disease (COVID-19) and sociodemographic and clinical variables in older adults. However, few studies have described the explanatory factors of the relationship between these variables and the clinical severity of COVID-19 using structural equation modeling.

OBJECTIVE

To analyze the factors directly and indirectly associated with the clinical severity of coronavirus disease (COVID-19) among older adults in Minas Gerais, Brazil.

DESIGN AND SETTING

Retrospective epidemiological study.

METHODS

This study included 51,141 elderly adults with COVID-19 living in Minas Gerais, Brazil. Data were collected through the Individual Registration Form - Hospitalized Cases of Severe Acute Respiratory Syndrome from January 28, 2020, to January 27, 2022.

RESULTS

Older age (P < 0.001), male sex (P < 0.001), dyspnea (P < 0.001), change in chest X-ray examination findings (P < 0.001), greater number of risk factors/comorbidities (P < 0.001), and longer hospitalization time (P < 0.001) were directly associated with the clinical severity of COVID-19. Female sex, mediated by the greater number of risk/comorbidity factors (β = -0.02, P < 0.001), and younger age, mediated by longer hospitalization time (β = -0.01; P < 0.001), were indirectly associated with the clinical severity of COVID-19.

CONCLUSION

Demographic and clinical variables were directly associated with increased disease severity. In addition to the direct effect, a greater number of risk/comorbidity factors and longer hospitalization time mediated the association between demographic variables and outcomes.

Uptake of COVID-19 vaccine and associated factors among Health Care Workers at Queen Elizabeth Central Hospital in Malawi: A cross-section study

Globally, the introduction of the Coronavirus Disease of 2019 (COVID-19) vaccine within one year of the pandemic brought doubts to the general population including health professionals. Even though Health Care Workers (HCWs) are at a high risk of contracting and transmitting the coronavirus due to their work, their COVID-19 vaccine uptake is unknown. This study aimed to determine the uptake of the COVID-19 vaccine and identify factors associated with uptake among HCWs at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi. We conducted a quantitative cross-sectional study at QECH. HCWs over 18 years, and with at least one year working experience at QECH were recruited using a simple random sampling technique between December 2021 and February 2022. Data were collected on sociodemographic characteristics, medical history, COVID-19 and COVID-19 vaccine perspectives. The study was informed by Behavioral and Social Drivers of COVID-19 Vaccination framework. We computed vaccine uptake as number of HCWs fully vaccinated divided by total number of participants recruited in the study. Bivariate and multivariable logistic regression models were used to identify factors associated with vaccine uptake. Of the 273 HCWs enrolled into the study 71% were fully vaccinated. Gender (Adjusted Odds Ratio (AOR) = 0.54, 95% CI: 0.30-0.96), ownership of medical insurance schemes (AOR = 2.90, 95% CI: 1.36-6.18) and history of vaccine refusal (AOR = 0.29, 95% CI: 0.12-0.70) were significantly related to vaccine uptake. Age and work experience were statistically significant. The level of education, the income of HCWs and occupation did not determine whether HCWs got vaccinated against COVID-19. There was high vaccine uptake among HCWs at QECH. Some risk factors for severe COVID-19 such as advancing in age and work experience are persuasive to COVID-19 vaccination. We recommend intensified COVID-19 vaccination campaigns for subgroups such as young adults and female HCWs.

Investigating the effects of COVID-19 on sperm in male smokers: A prospective integrated proteomic and metabolomic study

Notable variations in semen parameters among non-smoking males have been documented post-COVID-19 pandemic. The role of smoking as a significant contributing factor to male infertility has been substantiated. Does the combined effect of smoking and SARS-CoV-2 infection impact male reproductive function? A prospective descriptive cohort study was performed using data from 90 smoking and 90 non-smoking males before and after coronavirus infection in a single center over a period of 3 months. Semen samples were collected before and within 15 days after COVID-19 infection, ensuring no more than three months elapsed between the two collections. The semen parameters evaluated included volume, concentration, progressive motility, normal morphology, and DNA fragmentation rate. Proteomic and metabolomic studies were further used to explore the differences between groups. Both non-smokers and smokers exhibited a marked reduction in sperm concentration, progressive motility, and normal morphology rate. Additionally, an increase in sperm DNA fragmentation index was noted for non-smokers and smokers. In the non-smoking group, dysregulation proteins including SEMG1, SEMG2 and DNAH5, and metabolites including L-glutamine, cis-9-Palmitoleic acid and Linoleamide were observed. In smokers, dysregulation proteins including SMCP, ROPN1B and IZUMO4, alongside metabolites including carnitine, gamma-Glutamylglutamic acid, and hypoxanthine were found. Comparative analysis between smoking and non-smoking patients post-COVID-19 also revealed significant differences in semen concentration, morphology and sperm DNA fragmentation rate. Dysregulated proteins including HSPA5, HSPA2 and PGK2, and metabolites such as acetylcarnitine, oxaloacetate and nicotinate were associated with impaired sperm function. Our study demonstrates that the virus also significantly compromises sperm quality in smoking males, who experience more pronounced declines post-infection compared to their non-smoking counterparts. This research underscores the necessity for comprehensive fertility assessments for smoking males after recovering from COVID-19.

Reversible effects of the SARS-CoV-2 on semen parameters

Despite that the SARS-CoV-2 pandemic has been controlled, it has affected a large proportion of the population, raising some concerns about potential sequelae in men at reproductive age. To contribute to the clarification of this issue, we performed a retrospective study comparing semen parameters values before and after confirmed SARS-CoV-2 infection in a large cohort of infertile men, compared to a control group that did not undergo SARS-CoV-2 infection. Wilcoxon test on paired samples and general linear regression model showed that SARS-CoV-2 infection has a detrimental effect on semen volume values (p < 0.005). However, semen volume seems to be significantly lower only during the first spermatogenic cycle after SARS-COV-2 infection (p < 0.005) and mainly in unvaccinated patients (p < 0.05). In addition, we detected alterations in progressive motility in patients infected with the alpha SARS-COV-2 strain (p < 0.05). In conclusion, our results show that although SARS-CoV-2 has a small effect on semen volume and sperm motility in infertile men, depending on the infectious strain or vaccination status, pre-infection values of semen parameters appear to be restored over one spermatogenic cycle after infection.

Borderline personality disorder traits and rates of NSSI during the COVID-19 pandemic: An initial investigation

Objective: The current study evaluated frequency of nonsuicidal self-injury (NSSI) and associated maladaptive traits between three time periods: pre-pandemic, early pandemic, and later pandemic. Participants: Two college student samples (n = 362; n = 337) were collected via two online studies. Method: Participants completed measures assessing maladaptive borderline personality traits, engagement in NSSI over the past month, and reasons for and types of NSSI engaged in across the lifetime. Results: Results demonstrated a stable and potentially a slight increase in general rates of NSSI over the course of the pandemic. Further, specific maladaptive traits that underly borderline personality disorder (i.e., despondence, fragility, self-disturbance, and anxious-uncertainty) were related to engagement in NSSI 1-month post COVID. Conclusion: The study highlights the need for added interventions that might reach at risk populations during these heightened periods of stress.

Identification of fungal pathogens among COVID-19 and non COVID-19 cases in Bhaktapur hospital, Nepal

OBJECTIVES

Patients with coronavirus disease 2019 (COVID-19) are at increased risk of opportunistic fungal infections. This study aims to identify fungal pathogens among COVID positive and negative patients, assess their antifungal susceptibility and evaluate biofilm forming ability of Candida spp. A cross-sectional study was conducted among sputum samples from 135 COVID positive and 101 COVID negative cases. Fungal pathogens were identified by conventional culture methods. Antifungal susceptibility test of Candida isolates was done by disc diffusion method and biofilm production by microtiter plate method.

RESULTS

The prevalence of fungal pathogens among COVID-positive and negative cases was 6.70% and 22.77% respectively. In COVID positive cases, Candida albicans (33.33%) was predominantly followed by Aspergillus flavus 2(22.22%) and Candida tropicalis, Mucor spp. and Aspergillus fumigatus. In COVID negative cases, Candida albicans (69.60%) prevailed followed by Trichosporon spp., Candida parapsilosis, Mucor and Alternaria. Age and gender were not associated with fungal infection. Most Candida spp. were susceptible to miconazole but resistant to ketoconazole. To the best of our knowledge, this study represents the first report from Nepal on critical and high priority fungal pathogens categorized by WHO. With fungal infections on the rise, enhanced clinical vigilanceand antifungal susceptibility testing are warranted.

Comprehensive assessment of COVID-19 case fatality rate and influential factors in Khuzestan Province, Iran: a two-year study

BACKGROUND

The emergence of a new pandemic SARS-CoV-2 (COVID-19) resulted in a high mortality rate across the world. This study sought to comprehensively analyze the Case Fatality Rate (CFR) associated with COVID-19 in the Khuzestan province of Iran". The primary objective was to discern patterns and determinants influencing CFR, shedding light on the evolving impact of the pandemic on morbidity and mortality.

METHODS

A retrospective examination was performed on a dataset encompassing confirmed COVID-19 cases and related fatalities in Khuzestan. Data, spanning from December 2020 to April 2022, underwent rigorous statistical analysis. Demographic variables, comorbidities, and temporal trends were scrutinized to identify key factors influencing CFR.

RESULTS

Preliminary findings revealed dynamic shifts in CFR, capturing the nuanced nature of the pandemic over time. Demographic nuances, particularly age and gender, emerged as significant determinants impacting CFR, the reported CFR of COVID-19 in Khuzestan province was 1.79%.

CONCLUSION

This study contributes critical insights into the CFR landscape of COVID-19 in Khuzestan, providing a foundation for evidence-based decision-making in public health. The identified factors influencing mortality rates offer valuable information for tailoring interventions and optimizing resource allocation. Continuous monitoring and further investigations are recommended to adapt strategies to the evolving nature of the pandemic.

Unequal impact of COVID-19 on excess deaths, life expectancy, and premature mortality in Spanish regions (2020-2021)

OBJECTIVE

We aimed to estimate regional inequalities in excess deaths and premature mortality in Spain during 2020 and 2021, before high vaccination coverage against COVID-19.

METHOD

With data from the National Institute of Statistics, within each region, sex, and age group, we estimated the excess deaths, the change in life expectancy at birth (e0) and age 65 (e65) and years of life lost as the difference between the observed and expected deaths using a time series analysis of 2015-2019 data and life expectancies based on Lee-Carter forecasting using 2010-2019 data.

RESULTS

From January 2020 to June 2021, an estimated 89,200 (men: 48,000; women: 41,200) excess deaths occurred in Spain with a substantial regional variability (highest in Madrid: 22,000, lowest in Canary Islands: -210). The highest reductions in e0 in 2020 were observed in Madrid (men -3.58 years, women -2.25), Castile-La Mancha (-2.72, -2.38), and Castile and Leon (-2.13, -1.39). During the first half of 2021, the highest reduction in e0 was observed in Madrid for men (-2.09; -2.37 to -1.84) and Valencian Community for women (-1.63; -1.97 to -1.3). The highest excess years of life lost in 2020 was in Castile-La Mancha (men: 5370; women: 3600, per 100 000). We observed large differences between reported COVID-19 deaths and estimated excess deaths across the Spanish regions.

CONCLUSIONS

Regions performed highly unequally on excess deaths, life expectancy and years of life lost. The investigation of the root causes of these regional inequalities might inform future pandemic policy in Spain and elsewhere.

The impact of sex/gender-specific funding and editorial policies on biomedical research outcomes: a cross-national analysis (2000-2021)

Reflecting sex and gender characteristics in biomedical research is critical to improving health outcomes and reducing adverse effects from medical treatments. This study investigates the impact of sex/gender-specific funding policies and journal editorial standards on the integration of sex/gender analysis in biomedical research publications. Using data from the United States, Canada, the United Kingdom, and other countries between 2000 and 2021, we assessed how these policies influenced research output in the fields of medicine and life sciences. Our findings show that countries with progressive funding policies and journals promoting sex/gender-based reporting have significantly improved research quality and publication rates. This highlights the importance of coordinated policy efforts and editorial practices in advancing integrated sex/gender research. We recommend continued global efforts from policymakers, funding bodies, and journals to embed sex/gender perspectives in scientific inquiry, ensuring more effective and equitable biomedical advancements.

30 Years of Change: Declining Motor Fitness and Anthropometric Shifts in Polish University Students (1994-2024)

BACKGROUND

To assess changes in the anthropometric and motor characteristics of male and female Polish university students between 1994 and 2024.

METHODS

The first study was conducted in 1994 on 712 female and 495 male university students aged 19-25 years (19.94 ± 1.09), and the second study was conducted in 2024 on 323 female and 339 male university students aged 19-25 years (19.92 ± 1.08). The participants' body mass and height were measured, and the students participated in a modified version of Pilicz's test consisting of four motor ability tests. The changes in the students' performance over time were also analyzed in the context of their socioeconomic status (SES), including the place of permanent residence and the parents' education.

RESULTS

The students' BMI values (as well as body mass and body height in female students) were significantly higher (p < 0.001) in 2024 than in 1994. The male students examined in 1994 demonstrated significantly higher strength abilities in the medicine ball forward throw test. In turn, the females studied in 1994 received significantly better scores in motor ability tests, including the zig-zag run, 1-Minute Burpee Test, and the medicine ball forward throw (29.4 s, 22 cycles, 591.3 cm, respectively) than those examined in 2024 (30.1 s, 19.3 cycles, and 463.3 cm, respectively). The variations in the results were similar when the participants' SES was considered in the analysis, which suggests that these factors had no significant effect on the analyzed characteristics over time.

CONCLUSIONS

This study revealed a greater decline in the anthropometric and motor characteristics of female than male university students over a period of 30 years. The observed changes were not influenced by SES factors such as the place of permanent residence or the parents' education.

Prevalence, Risk Factors, and Impact of Long COVID Among Adults in South Korea

OBJECTIVES

This study aimed to identify the prevalence, risk factors, and impact of long COVID in a community-based representative sample of patients with COVID-19 aged 19-64 years.

METHODS

A total of 975 participants completed online or telephone surveys at 1 and 3 months post-diagnosis, covering persistent symptoms, daily activity limitations, vaccination status, and underlying diseases.

RESULTS

Long COVID, as defined by the WHO criteria, had a prevalence of 19.7-24.9% in females and 12.7% in males. Logistic regression revealed that the odds of having long COVID symptoms were higher among females compared to males (OR, 2.43; 95% CI, 1.53-3.87), and higher in those aged ≥ 30 years compared to those aged 19-29 years: 30-39 years (OR, 2.91; 95% CI, 1.59-5.33), 40-49 years (OR, 2.72; 95% CI, 1.51-4.89), and 50-64 years (OR, 1.96; 95% CI, 1.10-3.49). Additionally, patients with underlying diseases had higher odds of long COVID symptoms compared to those without underlying diseases (OR, 1.81; 95% CI, 1.24-2.64). Among those with long COVID, 54.2% experienced daily activity limitations, and 40.6% received treatment. Furthermore, lower income groups faced greater daily activity limitations but had similar treatment rates to higher income groups.

CONCLUSIONS

These findings emphasize the need for interest in and the development of programs to support these low-income populations.

Transmission of SARS-CoV-2 among underserved pastoralist communities in Kajiado County, Kenya: 2020-2022

Initial transmission of severe acute respiratory syndrome virus-2 (SARS-CoV-2) was highest in densely populated regions of Kenya. Transmission gradually trickled down to the less densely populated, remote and underserved regions such as the pastoral regions of Kajiado County which are characterized by poor healthcare systems. Molecular assays that were pivotal for COVID-19 diagnosis were not available in these regions. Serology is an alternative method for retrospectively tracking the transmission of SARS-CoV-2 in such populations. Dry blood spots (DBS) were prepared from consenting patients attending six health facilities in Kajiado County from March 2020 to March 2022. Upon elution, we conducted an enzyme-linked immunosorbent assay (ELISA) for the detection of SARS-Cov-2 IgG antibodies. Of the 908 DBSs we analyzed, 706 (78%) were from female participants. The overall seropositivity to SARS-Cov-2 antibodies was 7.3% (95% CI 5.7-9.1). The elderly (over 60 years) and male participants had a high likelihood of testing positive for SAR-CoV-2 infections. Mashuru (15.6%, 14/90) and Meto (15%, 19/127) health facilities registered the highest proportion of seropositive participants. Evidence of SARS-CoV-2 transmission among pastoralists in the remote and underserved regions of Kajiado County was established by DBS sampling and serologic testing.

Post-COVID-19 Pain Is Not Associated with DNA Methylation Levels of the ACE2 Promoter in COVID-19 Survivors Hospitalized Due to SARS-CoV-2 Infection

One of theories explaining the development of long-lasting symptoms after an acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection include changes in the methylation pattern of the host. The current study aimed to investigate whether DNA methylation levels associated with the angiotensin-converting enzyme 2 (ACE2) promoter are different when comparing individuals previously hospitalized due to COVID-19 who then developed long-lasting post-COVID pain with those previously hospitalized due to COVID-19 who did not develop post-COVID-19 pain symptoms. Non-stimulated saliva samples were obtained from a cohort of 279 (mean age: 56.5, SD: 13.0 years old, 51.5% male) COVID-19 survivors who needed hospitalization. Clinical data were collected from hospital medical records. Participants were asked to disclose pain symptoms developed during the first three months after hospital admission due to COVID-19 and persisting at the time of the interview. Methylations of five CpG dinucleotides in the ACE2 promoter were quantified (as percentages). Participants were evaluated up to 17.8 (SD: 5.3) months after hospitalization. Thus, 39.1% of patients exhibited post-COVID-19 pain. Most patients (77.05%) in the cohort developed localized post-COVID-19 pain. Headache and pain in the lower extremity were experienced by 29.4% of the patients. Seven patients received a post-infection diagnosis of fibromyalgia based on the presence of widespread pain characteristics (11.6%) and other associated symptoms. No significant differences in methylation percentages at any CpG location of the ACE2 promoter were identified when comparing individuals with and without post-COVID-19 pain. The current study did not observe differences in methylation levels of the ACE2 promoter depending on the presence or absence of long-lasting post-COVID-19 pain symptoms in individuals who needed hospitalization due to COVID-19 during the first wave of the pandemic.

CLINICAL PROFILES AND OUTCOMES OF ADMISSIONS FOLLOWING COVID-19 ADMISSIONS DURING THREE WAVES OF THE PANDEMIC: EXPERIENCE OF A TERTIARY HOSPITAL IN THE EASTERN CAPE PROVINCE OF SOUTH AFRICA

Background

South Africa was the country worst affected by the Covid-19 pandemic in Africa. There is a paucity of data on the clinical characteristics and mortality of Covid-19 from the Eastern Cape province of South Africa. We report on the demographic and clinical characteristics as well as the mortality of patients admitted to the Covid-19 ward of Nelson Mandela Academic Hospital (NMAH), Mthatha, during three waves of the Covid-19 pandemic in South Africa.

Materials and Methods

We conducted a single centre retrospective observational study of patients admitted for Covid-19 in a tertiary hospital in the rural Eastern Cape of South Africa. Data were collected from patient files, electronic databases and the National Health Laboratory Services (NHLS) database. The outcomes were duration of admission and in-hospital mortality.

Results

There were 371 patients admitted across all three waves with a mean age of 52.2 ± 16.3 years. The proportion of females across the three waves is 61.2%. The commonly associated comorbidities, irrespective of the wave, were hypertension, diabetes and HIV infection. The median duration of admission was six days, with an overall mortality of 31%. The mortality for first, second and third wave were 29.3%, 31.5% and 37.9% respectively.

Conclusion

Admissions for Covid-19 were predominantly in females and middle-aged. One third of the admitted patients died. Diabetes, hypertension and HIV infection were the most commonly associated comorbidities.

Sex-specific biphasic alpha-synuclein response and alterations of interneurons in a COVID-19 hamster model

BACKGROUND

Coronavirus disease 2019 (COVID-19) frequently leads to neurological complications after recovery from acute infection, with higher prevalence in women. However, mechanisms by which SARS-CoV-2 disrupts brain function remain unclear and treatment strategies are lacking. We previously demonstrated neuroinflammation in the olfactory bulb of intranasally infected hamsters, followed by alpha-synuclein and tau accumulation in cortex, thus mirroring pathogenesis of neurodegenerative diseases such as Parkinson's or Alzheimer's disease.

METHODS

To uncover the sex-specific spatiotemporal profiles of neuroinflammation and neuronal dysfunction following intranasal SARS-CoV-2 infection, we quantified microglia cell density, alpha-synuclein immunoreactivity and inhibitory interneurons in cortical regions, limbic system and basal ganglia at acute and late post-recovery time points.

FINDINGS

Unexpectedly, microglia cell density and alpha-synuclein immunoreactivity decreased at 6 days post-infection, then rebounded to overt accumulation at 21 days post-infection. This biphasic response was most pronounced in amygdala and striatum, regions affected early in Parkinson's disease. Several brain regions showed altered densities of parvalbumin and calretinin interneurons which are involved in cognition and motor control. Of note, females appeared more affected.

INTERPRETATION

Our results demonstrate that SARS-CoV-2 profoundly disrupts brain homeostasis without neuroinvasion, via neuroinflammatory and protein regulation mechanisms that persist beyond viral clearance. The regional patterns and sex differences are in line with neurological deficits observed after SARS-CoV-2 infection.

FUNDING

Federal Ministry of Health, Germany (BMG; ZMV I 1-2520COR501 to G.G.), Federal Ministry of Education and Research, Germany (BMBF; 03COV06B to G.G.), Ministry of Science and Culture of Lower Saxony in Germany (14-76403-184, to G.G. and F.R.).

Detection and Characterisation of SARS-CoV-2 in Eastern Province of Zambia: A Retrospective Genomic Surveillance Study

Mutations have driven the evolution and development of new variants of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with potential implications for increased transmissibility, disease severity and vaccine escape among others. Genome sequencing is a technique that allows scientists to read the genetic code of an organism and has become a powerful tool for studying emerging infectious diseases. Here, we conducted a cross-sectional study in selected districts of the Eastern Province of Zambia, from November 2021 to February 2022. We analyzed SARS-CoV-2 samples (n = 76) using high-throughput sequencing. A total of 4097 mutations were identified in 69 SARS-CoV-2 genomes with 47% (1925/4097) of the mutations occurring in the spike protein. We identified 83 unique amino acid mutations in the spike protein of the seven Omicron sublineages (BA.1, BA.1.1, BA.1.14, BA.1.18, BA.1.21, BA.2, BA.2.23 and XT). Of these, 43.4% (36/83) were present in the receptor binding domain, while 14.5% (12/83) were in the receptor binding motif. While we identified a potential recombinant XT strain, the highly transmissible BA.2 sublineage was more predominant (40.8%). We observed the substitution of other variants with the Omicron strain in the Eastern Province. This work shows the importance of pandemic preparedness and the need to monitor disease in the general population.

mRNA-LNP vaccine-induced CD8+ T cells protect mice from lethal SARS-CoV-2 infection in the absence of specific antibodies

The role of CD8+ T cells in SARS-CoV-2 pathogenesis or mRNA-LNP vaccine-induced protection from lethal COVID-19 is unclear. Using mouse-adapted SARS-CoV-2 virus (MA30) in C57BL/6 mice, we show that CD8+ T cells are unnecessary for the intrinsic resistance of female or the susceptibility of male mice to lethal SARS-CoV-2 infection. Also, mice immunized with a di-proline prefusion-stabilized full-length SARS-CoV-2 Spike (S-2P) mRNA-LNP vaccine, which induces Spike-specific antibodies and CD8+ T cells specific for the Spike-derived VNFNFNGL peptide, are protected from SARS-CoV-2 infection-induced lethality and weight loss, while mice vaccinated with mRNA-LNPs encoding only VNFNFNGL are protected from lethality but not weight loss. CD8+ T cell depletion ablates protection in VNFNFNGL but not in S-2P mRNA-LNP-vaccinated mice. Therefore, mRNA-LNP vaccine-induced CD8+ T cells are dispensable when protective antibodies are present but essential for survival in their absence. Hence, vaccine-induced CD8+ T cells may be critical to protect against SARS-CoV-2 variants that mutate epitopes targeted by protective antibodies.

Cancer Care During the COVID-19 Pandemic: A Retrospective Study From a Najran Oncology Center

Background The COVID-19 pandemic significantly impacted healthcare systems globally, with cancer patients representing a particularly vulnerable group. This study aims to evaluate the influence of COVID-19 on cancer, focusing on infection rates, types of care, therapy adjustments, and factors associated with COVID-19 infection. Materials and methods This single-center retrospective analysis included adult cancer patients who underwent anticancer therapy at King Khalid Hospital in Najran, Saudi Arabia, from December 20, 2020, to January 23, 2022. Data on patient and cancer characteristics, COVID-19 specifics, treatment delays, outcomes, and factors associated with COVID-19 were collected and analyzed. Results A total of 257 chemotherapy recipients were interviewed. The mean age was 52.6 ± 14.4 years, with 44 (17.1%) over 65 years old. Females comprised 160 (62.3%) of the patients. The most common malignancies were gastrointestinal (71, 27.6%), breast (70, 27.2%), and hematological (50, 19.5%). Metastasis was present in 116 patients (45.1%). Common comorbidities included diabetes (68, 26.5%) and hypertension (55, 21.4%). Most patients (226, 87.9%) were vaccinated against COVID-19. COVID-19 tested positive in 22 patients (8.6%), with a lower infection rate in vaccinated patients (7 vs. 15, p < 0.001). Most cases were mild (18, 81.8%), with fever (19, 7.4%) and cough and fatigue (17, 6.6%) being the most common symptoms. The median time to resume treatment post-infection was 30 days. Factors associated with higher infection rates included diabetes (OR: 4.73, 95% CI: 1.94-12.03, p = 0.001), coronary artery disease (OR: 4.13, 95% CI: 1.07-13.30, p = 0.049), chronic lung disease (OR: 15.58, 95% CI: 5.37-45.79, p < 0.001), chronic liver disease (OR: 7.64, 95% CI: 2.38-22.98, p < 0.001), and multiple comorbidities (OR: 2.04, 95% CI: 1.46-2.90, p < 0.001), cancer patients who received chemotherapy (OR: 1.02, 95% CI: 0.12-12.79, p = 0.027), and immunotherapy (OR: 3.37, 95% CI:1.27-8.43, p = 0.012). Conclusion The incidence of COVID-19 in cancer patients is proportional to the prevalence in the general population of similar geographic areas. Diabetes, coronary artery disease, chronic lung disease, chronic liver disease, receiving chemotherapy or immunotherapy, and multiple comorbidities were associated with higher COVID-19 infection rates.

The Politics of the Gender Gap in COVID-19: Partisanship, Health Behavior, and Policy Preferences in the United States

Several studies demonstrate gender and partisan differences among Americans in COVID-19 socioeconomic consequences, attitudes, and behaviors. The authors of this study use six waves of panel survey data to explore the intersection of gender and party across COVID-19 mitigation behaviors, concerns, and policy preferences. The authors observe small gender gaps on several measures; however, partisan differences are larger than gender differences when considering the interaction between gender and partisanship. Democratic women are more similar to Democratic men on these measures than to Republican women. On virtually all measures, Republican women report lower levels of mitigation behaviors, worries, and support for expansive government policies compared to Democratic women and men. Analyzing the interaction of gender and partisanship illuminates how individuals navigated the pandemic with respect to identity factors that often pull in different directions. These findings suggest that one's partisan identity is more consequential than gender when it comes to COVID behaviors, concerns, and policy preferences.

Association of TLR8 Variants in Sex-Based Clinical Differences in Patients with COVID-19

The host immune response might confer differential vulnerability to SARS-CoV-2 infection. The Toll-like receptor 8 (TLR8), could participated for severe COVID-19 outcomes. To investigated the relationship of TLR8 rs3764879-C/G, rs3764880-A/G, and rs3761624-A/G with COVID-19 outcomes and with biochemical parameters. A cross-sectional study of 830 laboratory-confirmed COVID-19 patients was performed, and classified into mild, severe, critical, and deceased outcomes. The TLR8 rs3764879-C/G, rs3764880-A/G, and rs3761624-A/G polymorphisms were genotyped. A logistic regression analysis was performed to determinate the association with COVID-19. A stratified analysis was by alleles was done with clinical and metabolic markets. In all outcomes, men presented the highest ferritin levels compared to women (P < 0.001). LDH levels were significantly different between sex in mild (P = 0.003), severe (P < 0.001) and deceased (P = 0.01) COVID-19 outcomes. The GGG haplotype showed an Odds Ratio of 1.55 (Interval Confidence 95% 1.05-2.32; P = 0.03) in men. Among patients with severe outcome, we observed that the carriers of the GGG haplotype had lower Ferritin, C-reactive protein and LDH levels than the CAA carriers (P < 0.01). After further stratified by sex, these associations were also seen in the male patients, except for D-dimer. Interestingly, among men patients, we could observe associations between TLR8 haplotypes and Ferritin (P < 0.001), D-dimer (P = 0.04), C-reactive protein, and Lactate dehydrogenase in mild (P = 0.04) group. Our results suggest that even though TLR8 haplotypes show a significant association with COVID-19 outcomes, they are associated with clinical markers in COVID-19 severity.

The Interleukin-6 gene variants may protect against SARS-CoV-2 infection and the severity of COVID-19: a case-control study in a Moroccan population

The symptoms of SARS-CoV-2 infection vary widely, ranging from asymptomatic cases to severe forms marked by acute respiratory distress syndrome, multi-organ damage, and fatalities. Studies indicate a correlation between specific genes and susceptibility to SARS-CoV-2 infection and disease severity, particularly involving variants in genes linked to inflammation and immune responses. The objective of this study is to investigate the association between rs1800795 (- 174 G > C) and rs1800797 (- 597 A > G) variants in the interleukin-6 (IL-6) promoter region and susceptibility to SARS-CoV-2 infection. Additionally, we aim to explore their correlation with COVID-19 severity in a Moroccan population. In this case-control study, we enrolled 270 unvaccinated COVID-19 patients, consisting of 132 with severe COVID-19 and 138 with asymptomatic-moderate COVID-19. Additionally, we included 339 SARS-CoV-2-negative group. Genotyping of rs1800795 and rs1800797 polymorphisms of the IL-6 gene was performed using predesigned TaqMan SNP genotyping. The median age of SARS-CoV-2-negative controls was 50 years, while severe COVID-19 cases exhibited a median age of 61 years. Additionally, individuals with asymptomatic to moderate COVID-19 had a median age of 36 years. We observed a significant age difference between severe and mild COVID-19 patients (p < 0.0001), and an association was noted between gender and the severity of COVID-19 (p = 0.011). The allele and genotype frequencies of the IL-6 - 597G > A and - 174G > C variants did not show significant associations with susceptibility to SARS-CoV-2 infection (p > 0.05). However, further analysis revealed that the linkage disequilibrium between rs1800797 and rs1800795 indicated that individuals with the GC* haplotype (OR = 0.04, 95% CI 0.01-0.30, p = 0.001) and AG* haplotype (OR = 0.11, 95% CI 0.03-0.46, p = 0.002) were significantly associated with protection against SARS-CoV-2 infection. Moreover, in the overdominant model, the IL-6 - 174 G/C genotype was found to be protective against the development of severe disease compared to those with the G/G-C/C genotypes (p = 0.03; OR = 0.41, 95% CI 0.18-0.96). However, correlations between complete blood count markers, hematological markers, D-dimer, C-reactive protein, and ferritin levels according to - 597 A > G and - 174G > C genotypes showed no significant differences (all p > 0.05). Our findings provide valuable insights into the pathogenesis of COVID-19, suggesting that genetic variations at the IL-6 gene may contribute to the susceptibility to severe SARS-CoV-2 infection within the Moroccan population.

The Impact of COVID-19 on the Tuberculosis Features in a Romanian Pneumology Hospital

Introduction

The COVID-19 pandemic and tuberculosis have epidemiological similarities, being transmitted airborne, favored by direct contact, crowded environments, and vulnerable biological status.

Methods

We performed a retrospective study of 45 cases of pulmonary tuberculosis associated with COVID-19 (TB+COV+) compared to 45 cases with tuberculous monoinfection (TB+COV-), hospitalized during 2021-2022.

Results

The demographic characteristics were similar in the two groups, predominating men, a median age of 51 years, living in rural areas, medium level of education and smoking. Common symptoms of the two groups were cough, weight loss, profuse sweating, loss of appetite and hemoptysis, while fever, headache, myo-arthralgias, and digestive symptoms characterized the TB+COV+ forms. The scores of radiological lesions in the TB+COV+ compared to TB+COV- group were significantly higher and persistent, revealing more frequent bilateral extensive lung lesions. There were no significant differences in the biological parameters between the two groups. Mortality was 2.2%, regardless of the association of COVID-19. The frequency of infections with Clostridioides difficile was higher in TB+COV+ cases.

Conclusion

The co-infection of COVID-19 had a mild impact on the clinical and biological expression of tuberculosis diagnosed in a pandemic context.

"For a man to go to hospital, then that would be his last option": A qualitative study exploring men's experiences, perceptions and healthcare needs in the implementation of Universal Health Coverage in Kenya

The achievement of Universal Health Coverage (UHC) requires equitable access and utilization of healthcare services across all population groups, including men. However, men often face unique barriers that impede their engagement with health systems which are influenced by a myriad of socio-cultural, economic, and systemic factors. Therefore, understanding men's perspectives and experiences is crucial to identifying barriers and facilitators to their healthcare-seeking behaviour under UHC initiatives. This qualitative study sought to explore men's perceptions, experiences, healthcare needs and potential strategies to inform an impartial implementation of Universal Health Coverage (UHC) in Kenya. The study employed a qualitative research design to investigate men's healthcare experiences in 12 counties across Kenya. Thirty focus group discussions involving 296 male participants were conducted. Men were purposively selected and mobilized through the support of health facility-in-charges, public health officers, and community health extension workers. Data was coded according to emergent views and further categorized thematically into three main domains (1) Perspectives and experiences of healthcare access (2) Socio-cultural beliefs and societal expectations (3) Desires and expectations of health systems. Findings revealed complex sociocultural, economic, and health system factors that influenced men's healthcare experiences and needs which included: masculinity norms and gender roles, financial constraints and perceived unaffordability of services, lack of male-friendly and gender-responsive healthcare services, confidentiality concerns, and limited health literacy and awareness about available UHC services. Our study has revealed a disconnect between men's needs and the current healthcare system. The expectations concerning masculinity further exacerbate the problem and exclude men further hindering men's ability to receive appropriate care. This data provides important considerations for the development of comprehensive and gender-transformative approaches challenging harmful masculine norms, pushing for financial risk protection mechanisms and gender-responsive healthcare delivery attuned to the unique needs and preferences of men.

Burden of COVID-19 pandemic on tuberculosis hospitalisation patterns at a tertiary care hospital in Rajasthan, India: a retrospective analysis

OBJECTIVE

This study aimed to investigate the burden of the COVID-19 pandemic on tuberculosis (TB) trends, patient demographics, disease types and hospitalisation duration within the Respiratory Medicine Department over three distinct phases: pre-COVID-19, COVID-19 and post-COVID-19.

DESIGN

Retrospective analysis using electronic medical records of patients with TB admitted between June 2018 and June 2023 was done to explore the impact of COVID-19 on patients with TB. The study employed a meticulous segmentation into pre-COVID-19, COVID-19 and post-COVID-19 eras.

SETTING

National Institute of Medical Science Hospital in Jaipur, Rajasthan, India.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome includes patients admitted to the Respiratory Medicine Department of the hospital and secondary outcome involves the duration of hospital stay.

RESULTS

The study encompassed 1845 subjects across the three eras, revealing a reduction in TB incidence during the post-COVID-19 era compared with the pre-COVID-19 period (p<0.01). Substantial demographic shifts were observed, with 5.2% decline in TB incidence among males in the post-COVID-19 era (n=529) compared with the pre-COVID-19 era (n=606). Despite the decrease, overall TB incidence remained significantly higher in males (n=1460) than females (n=385), with consistently elevated rates in rural (65.8%) as compared with the urban areas (34.2%). Extended hospital stays were noted in the post-COVID-19 era compared with the pre-COVID-19 era (p<0.01).

CONCLUSION

The study underscores the influence of the COVID-19 pandemic on the TB landscape and hospitalisation dynamics. Notably, patient burden of TB declined during the COVID-19 era, with a decline in the post-COVID-19 era compared with the pre-COVID-19 era. Prolonged hospitalisation in the post-COVID-19 period indicates the need for adaptive healthcare strategies and the formulation of public health policies in a post-pandemic context. These findings contribute to a comprehensive understanding of the evolving TB scenario, emphasising the necessity for tailored healthcare approaches in the aftermath of a global health crisis.

The top 50 most-cited articles about COVID-19 and the complications of COVID-19: A bibliometric analysis

Background

This bibliometric analysis examines the top 50 most-cited articles on COVID-19 complications, offering insights into the multifaceted impact of the virus. Since its emergence in Wuhan in December 2019, COVID-19 has evolved into a global health crisis, with over 770 million confirmed cases and 6.9 million deaths as of September 2023. Initially recognized as a respiratory illness causing pneumonia and ARDS, its diverse complications extend to cardiovascular, gastrointestinal, renal, hematological, neurological, endocrinological, ophthalmological, hepatobiliary, and dermatological systems.

Methods

Identifying the top 50 articles from a pool of 5940 in Scopus, the analysis spans November 2019 to July 2021, employing terms related to COVID-19 and complications. Rigorous review criteria excluded non-relevant studies, basic science research, and animal models. The authors independently reviewed articles, considering factors like title, citations, publication year, journal, impact factor, authors, study details, and patient demographics.

Results

The focus is primarily on 2020 publications (96%), with all articles being open access. Leading journals include The Lancet, NEJM, and JAMA, with prominent contributions from Internal Medicine (46.9%) and Pulmonary Medicine (14.5%). China played a major role (34.9%), followed by France and Belgium. Clinical features were the primary study topic (68%), often utilizing retrospective designs (24%). Among 22,477 patients analyzed, 54.8% were male, with the most common age group being 26-65 years (63.2%). Complications of COVID-19 affected 13.9% of patients, with a recovery rate of 57.8%.

Conclusion

Analyzing these top-cited articles offers clinicians and researchers a comprehensive, timely understanding of influential COVID-19 literature. This approach uncovers attributes contributing to high citations and provides authors with valuable insights for crafting impactful research. As a strategic tool, this analysis facilitates staying updated and making meaningful contributions to the dynamic field of COVID-19 research.

Effect of SARS-CoV-2 and Toxoplasma gondii co-infection on IFN-γ and TNF-α expression and its impact on disease severity

The symptomatology of COVID-19 is dependent on the immune status and the cytokine response of the host. The cytokine level of the host is influenced by the presence of chronic persistent or latent infections with co-pathogens. Parasitic diseases are known to induce host immune-modulation which may impact the response to co-infection. Toxoplasmosis is a widespread protozoal infection that remains quiescent in its latent form to be re-activated during states of immune depression. Clinical data on the relation between toxoplasmosis and COVID-19 cytokine profile and symptomatology are still insufficient. Seventy-nine subjects were included in this study. Patients were diagnosed with COVID-19 by PCR. Serological testing for toxoplasmosis was performed by the detection of anti-Toxoplasma IgG antibodies, in addition to IgG avidity testing. IFN-γ and TNF-α levels were determined by RT-PCR. Among patients diagnosed with COVID-19, 67.1% were seronegative for anti-Toxoplasma IgG, while 32.9% were seropositive. High avidity was found in 10 cases (40% of seropositive cases), 4 of whom required ICU administration, while low avidity was found in 15 cases (60%), 7 of which were administered to the ICU. TNF-α and INF-γ levels were significantly higher in COVID-19 patients than in healthy control subjects. No significant association was found between the seroprevalence of toxoplasmosis and the presence of COVID-19 and its severity. Cytokines were significantly higher in both seropositive and seronegative COVID-19 patients than in their control counterparts. The high prevalence of toxoplasmosis merits further exploration of its relation to COVID-19 by mass studies.

Predictors of Severity of Influenza-Related Hospitalizations: Results From the Global Influenza Hospital Surveillance Network (GIHSN)

BACKGROUND

The Global Influenza Hospital Surveillance Network (GIHSN) has since 2012 provided patient-level data on severe influenza-like-illnesses from >100 participating clinical sites worldwide based on a core protocol and consistent case definitions.

METHODS

We used multivariable logistic regression to assess the risk of intensive care unit admission, mechanical ventilation, and in-hospital death among hospitalized patients with influenza and explored the role of patient-level covariates and country income level.

RESULTS

The data set included 73 121 patients hospitalized with respiratory illness in 22 countries, including 15 660 with laboratory-confirmed influenza. After adjusting for patient-level covariates we found a 7-fold increase in the risk of influenza-related intensive care unit admission in lower middle-income countries (LMICs), compared with high-income countries (P = .01). The risk of mechanical ventilation and in-hospital death also increased by 4-fold in LMICs, though these differences were not statistically significant. We also find that influenza mortality increased significantly with older age and number of comorbid conditions. Across all severity outcomes studied and after controlling for patient characteristics, infection with influenza A/H1N1pdm09 was more severe than with A/H3N2.

CONCLUSIONS

Our study provides new information on influenza severity in underresourced populations, particularly those in LMICs.

Characteristics of Hospitalized COVID-19 Patients at Admission and Factors Associated with Clinical Severity in Low- and Middle-Income Countries: An Observational Study

Despite the numerous articles published on the clinical characteristics and outcomes of COVID-19 with regard to high-income countries, little is known about patients in low- and middle-income countries (LMIC) in this context. The objective of this observational, prospective, hospital-based multicentric study was to describe clinical features and outcomes of laboratory-confirmed COVID-19 patients hospitalized in each of the participating centers in Bangladesh, Guinea, Ivory Coast, Lebanon, Madagascar, and Mali during the first year of the pandemic (March 5, 2020 to May 4, 2021). The study outcome was the clinical severity of COVID-19, defined as hospitalization in intensive care unit or death. Multivariate logistic regression models were performed to identify independent variables associated with disease severity. Overall, 1,096 patients were included. The median age was 49.0 years, ranging from 38.0 in Mali to 63.0 years in Guinea. The overall clinical severity of COVID-19 was 12.3%, ranging from 6.4% in Mali to 18.8% in Guinea. In both groups of patients <60 and ≥60 years old, cardiovascular diseases (adjusted odds ratio [aOR]: 1.99; 95% CI: 1.13-3.50, P = 0.02; aOR: 2.47; 95% CI: 1.33-4.57, P = 0.004) were independently associated with clinical severity, whereas in patients <60 years, diabetes (aOR: 2.13; 95% CI: 1.11-4.10, P = 0.02) was also associated with clinical severity. Our findings suggest that COVID-19-related severity and death in LMICs are mainly driven by older age. However, the presence of chronic diseases can also increase the risk of severity especially in younger patients.

Liver injury in COVID-19: an insight into pathobiology and roles of risk factors

COVID-19 is a complex disease that can lead to fatal respiratory failure with extrapulmonary complications, either as a direct result of viral invasion in multiple organs or secondary to oxygen supply shortage. Liver is susceptible to many viral pathogens, and due to its versatile functions in the body, it is of great interest to determine how hepatocytes may interact with SARS-CoV-2 in COVID-19 patients. Liver injury is a major cause of death, and SARS-CoV-2 is suspected to contribute significantly to hepatopathy. Owing to the lack of knowledge in this field, further research is required to address these ambiguities. Therefore, we aimed to provide a comprehensive insight into host-virus interactions, underlying mechanisms, and associated risk factors by collecting results from epidemiological analyses and relevant laboratory experiments. Backed by an avalanche of recent studies, our findings support that liver injury is a sequela of severe COVID-19, and certain pre-existing liver conditions can also intensify the morbidity of SARS-CoV-2 infection in synergy. Notably, age, sex, lifestyle, dietary habits, coinfection, and particular drug regimens play a decisive role in the final outcome and prognosis as well. Taken together, our goal was to unravel these complexities concerning the development of novel diagnostic, prophylactic, and therapeutic approaches with a focus on prioritizing high-risk groups.

Description of the COVID-19 epidemiology in Malaysia

Introduction

Since the COVID-19 pandemic began, it has spread rapidly across the world and has resulted in recurrent outbreaks. This study aims to describe the COVID-19 epidemiology in terms of COVID-19 cases, deaths, ICU admissions, ventilator requirements, testing, incidence rate, death rate, case fatality rate (CFR) and test positivity rate for each outbreak from the beginning of the pandemic in 2020 till endemicity of COVID-19 in 2022 in Malaysia.

Methods

Data was sourced from the GitHub repository and the Ministry of Health's official COVID-19 website. The study period was from the beginning of the outbreak in Malaysia, which began during Epidemiological Week (Ep Wk) 4 in 2020, to the last Ep Wk 18 in 2022. Data were aggregated by Ep Wk and analyzed in terms of COVID-19 cases, deaths, ICU admissions, ventilator requirements, testing, incidence rate, death rate, case fatality rate (CFR) and test positivity rate by years (2020 and 2022) and for each outbreak of COVID-19.

Results

A total of 4,456,736 cases, 35,579 deaths and 58,906,954 COVID-19 tests were reported for the period from 2020 to 2022. The COVID-19 incidence rate, death rate, CFR and test positivity rate were reported at 1.085 and 0.009 per 1,000 populations, 0.80 and 7.57%, respectively, for the period from 2020 to 2022. Higher cases, deaths, testing, incidence/death rate, CFR and test positivity rates were reported in 2021 and during the Delta outbreak. This is evident by the highest number of COVID-19 cases, ICU admissions, ventilatory requirements and deaths observed during the Delta outbreak.

Conclusion

The Delta outbreak was the most severe compared to other outbreaks in Malaysia's study period. In addition, this study provides evidence that outbreaks of COVID-19, which are caused by highly virulent and transmissible variants, tend to be more severe and devastating if these outbreaks are not controlled early on. Therefore, close monitoring of key epidemiological indicators, as reported in this study, is essential in the control and management of future COVID-19 outbreaks in Malaysia.

Prevalence and risk factors associated with multidrug-resistant bacteria in COVID-19 patients

Bacterial coinfection among patients with confirmed coronavirus disease 2019 (COVID-19) is a critical medical concern that increases the disease severity and mortality rate. The current study is aimed at evaluating the effects of bacterial coinfections among COVID-19 patients, especially in relation to degree of severity and mortality. A retrospective study was conducted for patients with positive COVID-19 test, admitted to a regional COVID-19 hospital in Jeddah, Saudi Arabia, between May and August 2020. A specimen (e.g., blood, urine, or sputum) was collected from patients with confirmed COVID-19, and was cultured to determine bacterial coinfection caused by multidrug resistant (MDR) bacteria. COVID-19 patients were categorized into 2 groups based on the result of bacterial coinfection culture, as COVID-19 patients with coinfection and COVID-19 patients without coinfection. Independent sample t test or Mann-Whitney U test was used to compare age and hospitalization period between these groups. In addition, binominal logistic regression was applied to identify risk factors associated with mortality and bacterial coinfection. The study included 342 patients with laboratory confirmed COVID-19. Eighty (23.3%) patients were diagnosed with bacterial coinfection, while the remaining 262 (76.6%) patients did not test positive for bacterial coinfection. Length of hospital stay was prolonged among COVID-19 patients diagnosed with bacterial coinfection (16.01 ± 11.36 days) when compared with patients without bacterial coinfection (6.5 ± 6.12 days). Likewise, the mortality rate was significantly higher among COVID-19 patients with bacterial coinfection (90%) compared to those without bacterial coinfection (49.2%). Gram-negative bacteria were predominant compared to gram-positive, as Klebsiella pneumoniae (35 [43.8%]) and Acinetobacter baumanni (32 [40%]). On the other hand, Staphylococcus aureus (4 [5%]), Enterococcus faecalis (1 [1.3%]), and Enterococcus faecium (1 [1.3%]) were identified as gram-positive bacterial species from recruited patients. The findings of the current study showed that prolong hospitalization is the main risk factor associated with bacterial coinfection and death. Thus, health care providers should minimize hospitalization as well as following a continuous monitoring for bacterial coinfection among COVID-19 patients, to control the spread of infection and reducing the severity and mortality rate among COVID-19 patients.

Symptom trajectories of post-COVID sequelae in patients with acute Delta or Omicron infection in Bergen, Norway

Introduction

A substantial proportion of the over 700 million COVID-19 cases world-wide experience long-term symptoms. The objectives of this study were to compare symptom trajectories and risk factors for post-COVID-19 condition after Delta and Omicron infection.

Methods

This study consecutively recruited patients with SARS-CoV-2 infection from November 2021 to March 2022. We recorded demographics, comorbidities, vaccination status, sick leave, and 18 symptoms during acute infection and after 4 months. The primary outcome measures were symptoms during acute infection and after 4 months. Secondary outcome measures were work and school absenteeism.

Results

We followed a cohort of 1,374 non-hospitalized COVID-19 patients in Bergen, Norway, at three time points. The median age was 39.8 years and 11% were children <16 years. Common acute upper respiratory symptoms waned during follow-up. Fatigue remained common from acute infection (40%) until after 4 months (37%). Four months post-infection, patients reported increased frequencies of dyspnea (from 15% during acute illness to 25% at 4 months, p < 0.001), cognitive symptoms (from 9 to 32%, p < 0.001) and depression (from 1 to 17%, p < 0.001). Patients infected with Omicron reported less dyspnea (22% versus 27%, p = 0.046) and smell/taste problems (5% versus 19%, p < 0.001) at 4 months follow-up than those with Delta infection. Comorbidities and female sex were risk factors for persistent dyspnea and cognitive symptoms. Ten percent reported sick leave after acute illness, and vaccination reduced the risk of absenteeism (adjusted risk ratio: 0.36, 95% confidence interval: 0.15, 0.72, p = 0.008).

Conclusion

At 4 months, home-isolated patients infected with Omicron reported overall comparable symptom burden, but less dyspnea and smell/taste problems than Delta infected patients. Several acute symptoms waned during follow-up. It is worrying that dyspnea, neurocognitive symptoms, and particularly depression, increased significantly during the first 4 months after acute infection. Previous vaccination was protective against prolonged sick leave.

[Impact of COVID-19 on the mental health of the population: Study in primary care]

OBJECTIVE

To determine the prevalence of COVID-19 and the characteristics of infected patients, as well as the prevalence of mental disorders associated with the infection and the associated risk factors. Secondary: to know the prevalence of the long COVID syndrome and the characteristics of this cohort.

DESIGN

Incidence study of mental disorder in patients diagnosed with COVID-19 and case-control study of long COVID syndrome in the subsample of patients diagnosed with COVID-19 without a history of mental disorder. SITE: Primary care setting in Lleida.

PARTICIPANTS

The 46,258 patients diagnosed of COVID-19 without a history of mental disorder were followed for 2 years.

MAIN MEASUREMENTS

The dependent variable was the mental disorder in the period 03/11/2020 to 03/11/2022; and the independent variables were clinical and social variables. Its association with mental disorder was analyzed by calculating the adjusted hazard ratio using a logistic regression model.

RESULTS

The average age of 46,258 patients at the beginning of the study was 43±17.9 years. 47% were women. The mental disorder rate for all period was 3.46% (59.20% anxiety). A predictive score was elaborated. The long COVID syndrome was more common in older women, without toxic habits, with obesity and associated comorbidity.

CONCLUSIONS

COVID-19 has had an impact on the mental health of patients. Knowing the risk factors for developing these mental disorders and the long COVID syndrome would allow the clinician to be able to identify patients at risk in order to establish preventive measures and avoid their appearance.

Spectrum of EEG Abnormalities in COVID-19 Patients

PURPOSE

Neurologic involvement is commonly reported in coronavirus disease (COVID-19) patients. The published literature regarding the COVID-19-related neurophysiological findings, including the EEG findings, is still quite limited. The objective of this study was to evaluate the EEG findings in patients with a COVID-19 infection and look for a possible correlations and prognosis.

METHODS

This is an inpatient hospital-based retrospective observational study. All admitted COVID-19 patients undergoing an EEG study between January 1, 2020 and June 30, 2021 were included in this study. EEG was ordered by the primary intensive care physician or a neurologist taking part in the clinical care of patients.

RESULTS

Sixty-six EEG studies in 57 patients were included. Mean age was 62.2 ± 16.3 years with male predominance (65%). Encephalopathy (70%) was the most common indication for an EEG. Background EEG abnormalities were seen in most of the patients (92.4%) with severe abnormalities correlating with the prognosis of the patient. Epileptiform discharges were only seen in 7.5% of the EEGs, with majority of the discharges arising from the frontal region. Mortality reported was high (47%).

CONCLUSIONS

Nonspecific diffuse background EEG abnormalities are commonly seen in COVID-19 patients. Epileptiform discharges are less common but mostly originate from frontal region. Most of these patients also had an abnormal neuroimaging. The significance of this peculiar finding needs further research.

SIGNIFICANCE

Nonspecific background EEG changes are common in COVID-19 patients. Among epileptiform discharges, focal epileptiform discharges arising from the frontal region were common, usually associated with an abnormal neuroimaging.

Application of artificial intelligence (AI) to control COVID-19 pandemic: Current status and future prospects

The impact of the coronavirus disease 2019 (COVID-19) pandemic on the everyday livelihood of people has been monumental and unparalleled. Although the pandemic has vastly affected the global healthcare system, it has also been a platform to promote and develop pioneering applications based on autonomic artificial intelligence (AI) technology with therapeutic significance in combating the pandemic. Artificial intelligence has successfully demonstrated that it can reduce the probability of human-to-human infectivity of the virus through evaluation, analysis, and triangulation of existing data on the infectivity and spread of the virus. This review talks about the applications and significance of modern robotic and automated systems that may assist in spreading a pandemic. In addition, this study discusses intelligent wearable devices and how they could be helpful throughout the COVID-19 pandemic.

Pathophysiological, immunological, and inflammatory features of long COVID

The COVID-19 pandemic continues to cause severe global disruption, resulting in significant excess mortality, overwhelming healthcare systems, and imposing substantial social and economic burdens on nations. While most of the attention and therapeutic efforts have concentrated on the acute phase of the disease, a notable proportion of survivors experience persistent symptoms post-infection clearance. This diverse set of symptoms, loosely categorized as long COVID, presents a potential additional public health crisis. It is estimated that 1 in 5 COVID-19 survivors exhibit clinical manifestations consistent with long COVID. Despite this prevalence, the mechanisms and pathophysiology of long COVID remain poorly understood. Alarmingly, evidence suggests that a significant proportion of cases within this clinical condition develop debilitating or disabling symptoms. Hence, urgent priority should be given to further studies on this condition to equip global public health systems for its management. This review provides an overview of available information on this emerging clinical condition, focusing on the affected individuals' epidemiology, pathophysiological mechanisms, and immunological and inflammatory profiles.

Prepandemic Physical Activity and Risk of COVID-19 Diagnosis and Hospitalization in Older Adults

Importance

Higher prepandemic physical activity (PA) levels have been associated with lower risk and severity of COVID-19.

Objective

To investigate the association between self-reported prepandemic PA levels and the risk and severity of COVID-19 in older US adults.

Design, Setting, and Participants

This cohort study combined cohorts from 3 ongoing prospective randomized clinical trials of US adults aged 45 years or older who provided prepandemic self-reports of baseline leisure-time PA and risk factors for COVID-19 outcomes using the most recent questionnaire completed as of December 31, 2019, as the baseline PA assessment. In multiple surveys from May 2020 through May 2022, participants indicated whether they had at least 1 positive COVID-19 test result or were diagnosed with or hospitalized for COVID-19.

Exposure

Prepandemic PA, categorized into 3 groups by metabolic equivalent hours per week: inactive (0-3.5), insufficiently active (>3.5 to <7.5), and sufficiently active (≥7.5).

Main Outcome and Measures

Primary outcomes were risk of COVID-19 and hospitalization for COVID-19. Multivariable logistic regression was used to estimate odd ratios (ORs) and 95% CIs for the association of COVID-19 diagnosis and/or hospitalization with each of the 2 upper PA categories vs the lowest PA category.

Results

The pooled cohort included 61 557 participants (mean [SD] age, 75.7 [6.4] years; 70.7% female), 20.2% of whom were inactive; 11.4%, insufficiently active; and 68.5%, sufficiently active. A total of 5890 confirmed incident cases of COVID-19 were reported through May 2022, including 626 hospitalizations. After controlling for demographics, body mass index, lifestyle factors, comorbidities, and medications used, compared with inactive individuals, those insufficiently active had no significant reduction in infection (OR, 0.96; 95% CI, 0.86-1.06) or hospitalization (OR, 0.98; 95% CI, 0.76-1.28), whereas those sufficiently active had a significant reduction in infection (OR, 0.90; 95% CI, 0.84-0.97) and hospitalization (OR, 0.73; 95% CI, 0.60-0.90). In subgroup analyses, the association between PA and SARS-CoV-2 infection differed by sex, with only sufficiently active women having decreased odds (OR, 0.87; 95% CI, 0.79-0.95; P = .04 for interaction).

Conclusions and Relevance

In this cohort study of adults aged 45 years or older, those who adhered to PA guidelines before the pandemic had lower odds of developing or being hospitalized for COVID-19. Thus, higher prepandemic PA levels may be associated with reduced odds of SARS-CoV-2 infection and hospitalization for COVID-19.

The impact of long COVID on health-related quality of life in patients 6 months after discharge with severe COVID-19

This study investigates the relationship between long COVID and health-related quality of life (HRQOL) in patients discharged for 6 months. It included 192 patients with a history of severe COVID-19 and 192 patients with a history of non-severe COVID-19 patients that were selected through quota sampling methods from the Medical Care Monitoring Center (MCMC) of hospitals in Shiraz, Iran, in 2020. Phone-based interviews were conducted to collect data using the short form of the 12-item health-related quality of life (SF-12) questionnaire. Descriptive statistics, including mean (standard deviation) and frequency (percentage), were utilized. Statistical tests, such as the chi-squared test, independent samples t-test, Fisher's exact test, and multiple linear regression models were performed. Statistical analysis was performed using SPSS software version 24, with a significance level of 0.05. Among 384 patients, 79.95% were married, with a mean age of 53.95 years. The majority of patients in both groups were male (57.81% in the severe group and 51.04% in the non-severe group). Patients with severe COVID-19 had significantly lower quality of life scores compared to those with non-severe COVID-19 (p < 0.001, 34.45 [SD = 6.59] versus 39.64 [SD = 5.07]). Furthermore, multiple linear regression analysis indicated that severe COVID-19 inducts a significant negative effect on HRQOL in patients after adjustment of confounders (p < 0.001, B =  - 4.84). Patients with severe COVID-19 had lower HRQOL compared to those with a non-severe level. It is necessary to consider implementing policies aimed at providing social, psychological, or medical support to improve the HRQOL of patients with a history of severe COVID-19.

Genetic determinants of SARS-CoV-2 and the clinical outcome of COVID-19 in Southern Bangladesh

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has had a severe impact on population health. The genetic determinants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in southern Bangladesh are not well understood.

METHODS

This study aimed to determine the genomic variation in SARS-CoV-2 genomes that have evolved over 2 years of the pandemic in southern Bangladesh and their association with disease outcomes and virulence of this virus. We investigated demographic variables, disease outcomes of COVID-19 patients and genomic features of SARS-CoV-2.

RESULTS

We observed that the disease severity was significantly higher in adults (85.3%) than in children (14.7%), because the expression of angiotensin-converting enzyme-2 (ACE-2) diminishes with ageing that causes differences in innate and adaptive immunity. The clade GK (n = 66) was remarkable between June 2021 and January 2022. Because of the mutation burden, another clade, GRA started a newly separated clustering in December 2021. The burden was significantly higher in GRA (1.5-fold) highlighted in mild symptoms of COVID-19 patients than in other clades (GH, GK, and GR). Mutations were accumulated mainly in S (22.15 mutations per segment) and ORF1ab segments. Missense (67.5%) and synonymous (18.31%) mutations were highly noticed in adult patients with mild cases rather than severe cases, especially in ORF1ab segments. Moreover, we observed many unique mutations in S protein in mild cases compared to severe, and homology modeling revealed that those might cause more folding in the protein's alpha helix and beta sheets.

CONCLUSION

Our study identifies some risk factors such as age comorbidities (diabetes, hypertension, and renal disease) that are associated with severe COVID-19, providing valuable insight regarding prioritizing vaccination for high-risk individuals and allocating health care and resources. The findings of this work outlined the knowledge and mutational basis of SARS-CoV-2 for the next treatment steps. Further studies are needed to confirm the effects of structural and functional proteins of SARS-CoV-2 in detail for monitoring the emergence of new variants in future.

Uptake of COVID-19 and influenza vaccines in relation to preexisting chronic conditions in the European countries

BACKGROUND

The suboptimal uptake of COVID-19 and influenza vaccines among those with non-communicable chronic diseases is a public health concern, because it poses a higher risk of severe illness for individuals with underlying health conditions, emphasizing the need to address barriers to vaccination and ensure adequate protection for this vulnerable population. In the present study, we aimed to identify whether people with chronic illnesses are more likely to get vaccinated against COVID-19 and influenza in the European Union.

METHODS

Cross-sectional data on 49,253 men (n = 20,569) and women (n = 28,684) were obtained from the ninth round of the Survey of Health, Ageing and Retirement in Europe (June - August, 2021). The outcome variables were self-reported COVID-19 and influenza vaccine uptake status. The association between the uptake of the vaccines and six preexisting conditions including high blood pressure, high blood cholesterol, chronic lung disease, diabetes, chronic bronchitis, and asthma was estimated using binary logistic regression methods.

RESULTS

The vaccination coverage for COVID-19 ranged from close to 100% in Denmark (98.2%) and Malta (98.2%) to less than 50% in Bulgaria (19.1%) and Romania (32.7%). The countries with the highest percentage of participants with the influenza vaccine included Malta (66.7%), Spain (63.7%) and the Netherlands (62.5%), and those with the lowest percentage included Bulgaria (3.7%), Slovakia (5.8%) and Poland (9.2%). Participants with high blood pressure were 3% less likely [Risk difference (RD) = -0.03, 95% CI = -0.04, -0.03] to report taking COVID-19 and influenza [RD = -0.03, 95% CI= -0.04, -0.01] vaccine. Those with chronic lung disease were 4% less likely [RD = -0.04, 95% CI= -0.06, -0.03] to report taking COVID-19 and 2% less likely [RD= -0.02, 95% CI = -0.04, -0.01] to report taking influenza vaccine. Men and women with high blood pressure were 3% less likely to have reported taking both of the vaccines.

CONCLUSIONS

Current findings indicate a suboptimal uptake of COVID-19 and influenza vaccines among adult men and women in the EU countries. Those with preexisting conditions, including high blood pressure and chronic lung disease are less likely to take the vaccines.

Antigen non-specific CD8+ T cells accelerate cognitive decline in aged mice following respiratory coronavirus infection

Primarily a respiratory infection, numerous patients infected with SARS-CoV-2 present with neurologic symptoms, some continuing long after viral clearance as a persistent symptomatic phase termed "long COVID". Advanced age increases the risk of severe disease, as well as incidence of long COVID. We hypothesized that perturbations in the aged immune response predispose elderly individuals to severe coronavirus infection and post-infectious sequelae. Using a murine model of respiratory coronavirus, mouse hepatitis virus strain A59 (MHV-A59), we found that aging increased clinical illness and lethality to MHV infection, with aged animals harboring increased virus in the brain during acute infection. This was coupled with an unexpected increase in activated CD8+ T cells within the brains of aged animals but reduced antigen specificity of those CD8+ T cells. Aged animals demonstrated spatial learning impairment following MHV infection, which correlated with increased neuronal cell death and reduced neuronal regeneration in aged hippocampus. Using primary cell culture, we demonstrated that activated CD8+ T cells induce neuronal death, independent of antigen-specificity. Specifically, higher levels of CD8+ T cell-derived IFN-γ correlated with neuronal death. These results support the evidence that CD8+ T cells in the brain directly contribute to cognitive dysfunction following coronavirus infection in aged individuals.

Prognostic factors for deterioration of quality of life one year after admission to ICU for severe SARS-COV2 infection

PURPOSE

Patients with COVID-19 present long-term symptoms collectively known as "post-COVID syndrome". Long-term manifestations are more frequent in patients requiring admission to Intensive Care Units (ICU), but the risk factors for their development are still unknown. This study explores the quality of life of patients with severe COVID-19 one year after their discharge from ICU.

METHODS

Prospective observational study including 106 patients admitted to the ICU of a tertiary care hospital between March and August 2020. We analysed quality of life using the EuroQol-5D index (EQ-5D). We evaluated as possible risk factors associated with a worse value of the EQ-5D index the medical record, the clinical situation at hospital admission, the clinical situation at ICU admission and evolution in the ICU. As a secondary objective, we explored the presence of other frequent symptoms.

RESULTS

Most patients (55.4%) reported that their quality of life worsened one year after admission. The mean perceived health status, on the EQ-VAS scale (0-100), was 70.4, with a median of 70 (RI 60-90). The median EQ-5D index was 0.91 (RI 0.76-1). The factors independently related to lower quality of life were female sex and duration of mechanical ventilation. Almost all (91%) of the patients had sequelae one year after discharge from the ICU. The most frequent manifestations were neuropsychiatric (71%).

CONCLUSIONS

Critically ill COVID-19 patients worsen their quality of life more than one year after discharge. Female sex and duration of mechanical ventilation predict a lower quality of life assessed by the EQ-5D index.