A novel coronavirus outbreak of global health concern

Burnout among Catalan general practitioners. A repeated cross-sectional study, during and after the COVID-19 pandemic

BACKGROUND

COVID-19 pandemic caused a significant impact on healthcare workers' mental health and burnout, which continues after the pandemic.

OBJECTIVES

To assess the levels of burnout in general practitioners (GP) in Catalonia at three different times.

METHODS

Cross-sectional study involving members of the GPs' Catalan Society (n = 4700). A self-administered survey was sent via institutional email in June-July 2021 (T1), in March-April 2022 (T2), and in May-June 2023 (T3). Probable burnout was assessed through Maslach Burnout Inventory (MBI) test, with three independent dimensions: emotional exhaustion, depersonalisation, and personal achievement. A descriptive analysis was performed, as well as a comparison between T1, T2, and T3 results.

RESULTS

500 GPs responded in T1, 454 in T2, and 386 in T3. Samples were similar in demographic variables. Regarding burnout dimensions, the level of emotional exhaustion was 67.5% in T1, with a statistically significant decrease in T2 and T3 (56.4 and 58.1%, respectively, p = 0.001); levels of depersonalisation were 42.7% in T1, 37.0% in T2 and 36.7% in T3 (p = 0.091); levels of personal achievement were 29.9% in T1, 30.4% in T2 and 24.2% in T3 (p = 0.086).  Starting at high levels of emotional exhaustion and depersonalisation, the prevalence decreased significantly over time in two groups: women and GPs who worked <10 years at the same workplace.

CONCLUSION

Catalan GPs experienced significant burnout during the COVID-19 pandemic with emotional exhaustion being particularly high. Although the prevalence of burnout decreased slightly over time, over half of the participants consistently reported high levels of emotional exhaustion.

Organs on chips: fundamentals, bioengineering and applications

Human body constitutes unique biological system containing specific fluid mechanics and biomechanics. Traditional cell culture techniques of 2D and 3D do not recapitulate these specific natures of the human system. In addition, they lack the spatiotemporal conditions of representing the cells. Moreover, they do not enable the study of cell-cell interactions in multiple cell culture platforms. Therefore, establishing biological system of dynamic cell culture was of great interest. Organs on chips systems were fabricated proving their concept to mimic specific organs functions. Therefore, it paves the way for validating new drugs and establishes mechanisms of emerging diseases. It has played a key role in validating suitable vaccines for Coronavirus disease (COVID-19). Herein, the concept of organs on chips, fabrication methodology and their applications are discussed.

A detailed examination of coronavirus disease 2019 (COVID-19): Covering past and future perspectives

The COVID-19 disease has spread rapidly across the world within just six months, affecting 169 million people and causing 3.5 million deaths globally (2021). The most affected countries include the USA, Brazil, India, and several European countries such as the UK and Russia. Healthcare professionals face new challenges in finding better ways to manage patients and save lives. In this regard, more comprehensive research is needed, including genomic and proteomic studies, personalized medicines and the design of suitable treatments. However, finding novel molecular entities (NME) using a standard or de novo strategy to drug development is a time-consuming and costly process. Another alternate strategy is discovering new therapeutic uses for old/existing/available medications, known as drug repurposing. There are a variety of computational repurposing methodologies, and some of them have been used to counter the coronavirus disease pandemic of 2019 (COVID-19). This review article compiles recently published data on the origin, transmission, pathogenesis, diagnosis, and management of the coronavirus by drug repurposing and vaccine development approach. We have attempted to screen probable drugs in clinical trials by using literature survey. This systematic review aims to create priorities for future research of drugs repurposed and vaccine development for COVID-19.

The ongoing impact of policy documents on the pandemic based on the framework of the "4Rs" theory and policy tools: in China

BACKGROUND

Enhancing public health emergency (PHE) management capacities has become a critical challenge in global public health governance. During the Coronavirus Disease 2019 (COVID-19) pandemic, Shanghai and Shenzhen implemented region-specific measures tailored to local conditions, reflecting China's overarching control strategy. Systematically analysis of prevention and control policies is essential for optimizing PHE responses. While existing research has primarily focused on policy-outcome relationships through case studies or quantitative models, the application of policy tools across different pandemic stages remains underexplored.

METHODS

To analyze the distribution and evolution of policy tools across pandemic stages, this study integrated the policy tool perspective with the "4Rs" crisis management theory to construct a two-dimensional analytical framework. Quantitative text analysis was employed within this framework to code and quantify pandemic prevention and control policies issued between January 2020 and December 2022. Policy texts were collected from the official websites of local governments and the Peking University Law website.

RESULTS

From the perspective of policy tools, both Shanghai and Shenzhen predominantly relied on authority tools, followed by incentive tools, with system-changing tools being the least utilized. From the crisis management dimension, the frequency of policy tool usage peaked during the crisis outbreak period, dropped significantly during the crisis receding period, and slightly rebounded during the crisis recovery period. The two-dimensional analysis revealed that, apart from Shanghai's emphasis on incentive tools during the crisis receding period, authority tools dominated across all crisis management stages in both cities. Additionally, as the pandemic progressed, the use of capacity-building tools and incentive tools increased significantly.

CONCLUSIONS

Chinese local governments primarily applied authority tools to drive institutional improvements, complemented by incentive tools and capacity-building tools to enhance policy effectiveness and public engagement. Optimizing PHE management requires dynamic adjustments to policy tools based on crisis stage characteristics, balancing rigidity with flexibility and immediate responses with long-term system development. The findings may provide valuable references for governments worldwide in formulating follow-up PHE policies and offer a replicable framework for future analyses in this field.

Impact of COVID-19 pandemic on glycaemic and blood pressure control among patients with type 2 diabetes in primary care in Hong Kong

OBJECTIVES

To evaluate the impact of social distancing measures due to COVID-19 pandemic on glycemic and blood pressure control in primary care in Hong Kong.

METHODS

This was a retrospective cross-sectional study. Diabetic patients with regular follow-up in 8 public primary care clinics in Hong Kong within the study period were recruited. The outcomes were to detect any difference of HbA1c levels and BP between pre-pandemic group (2019 group) and the 1-year post-pandemic group (2020 group) in all patients and in sub-group analysis of different age groups, sex, body mass index, presence of diabetic complications and different diabetic treatment.

RESULTS

There was no statistically significant change in HbA1c level between 2020 and 2019 groups which was 0.019% (95% confidence interval [CI] -0.057% to 0.094%, p = 0.632). There was also no statistically significant change in both systolic and diastolic BP between 2020 and 2019 groups which were -0.143 mmHg (95%CI -1.005 mmHg to 0.719 mmHg, p = 0.745) and 0.148 mmHg (95%CI -0.422 mmHg to 0.718 mmHg, p = 0.611). Subgroup analysis showed that female gender had statistically significant improvement in glycaemic control (HbA1c 6.92% in 2020 group versus HbA1c 7.03% in 2019 group, p = 0.021). Patients with diabetic retinopathy had statistically significant lower diastolic BP (diastolic BP 73 mmHg in 2020 group versus diastolic BP 75 mmHg in 2019 group with p = 0.011).

CONCLUSIONS

Despite the implementation of various social distancing measures resulting in significant change in lifestyle, COVID-19 pandemic did not worsen glycaemic and blood pressure control in T2DM patients. In fact, slight improvement in glycaemic control among female patients was found.

TRIAL REGISTRATION

Not applicable.

A BSL-2 chimeric system designed to screen SARS-CoV-2 E protein ion channel inhibitors

A major hindrance to the identification of new drug targets and the large-scale testing of new or existing compound libraries against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is that research on the virus is restricted to biosafety level 3 (BSL-3) laboratories. In such cases, BSL-2 surrogate systems or chimeric and attenuated versions of the virus are developed for safer, faster, and cheaper examination of the stages of the virus life cycle and specific drug targets. In this study, we describe a BSL-2 chimeric viral system utilizing a Sindbis virus background as a tool to study one such target, the SARS-CoV-2 Envelope (E) protein channel activity. This protein is fully conserved between SARS-CoV and SARS-CoV-2 variants of concern (VOCs), except for a threonine to isoleucine mutation in the Omicron variant, making the E ion channel domain an attractive antiviral target for combination therapy. Using a BSL-2-chimeric system, we have been able to show similar inhibition profiles using channel inhibitors as previously reported for E-channel inhibition in authentic SARS-CoV-2. This system has the potential to allow faster initial screening of E-channel inhibitors and can be useful in developing broad-spectrum antivirals against viral channel proteins.IMPORTANCEDespite its importance in viral infections, no antivirals exist against the ion channel activity of the SARS-CoV-2 Envelope (E) protein. The E protein is highly conserved among SARS-CoV-2 variants, making it an attractive target for antiviral therapies. Research on SARS-CoV-2 is restricted to BSL-3 laboratories, creating a bottleneck for screening potential antiviral compounds. This study presents a BSL-2 chimeric system using a Sindbis virus background to study the ion channel activity of the E protein. This novel BSL-2 system bypasses this limitation, offering a safer and faster approach for the initial screening of ion channel inhibitors. By replicating the channel inhibition profiles of authentic SARS-CoV-2 in a more accessible system, this research paves the way for the development of broad-spectrum antivirals against viral channel proteins, potentially expediting the discovery of life-saving treatments for COVID-19 and other viral diseases.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Practicing pharmacist education based on the experiences of medical support on the cruise ship Diamond Princess

BACKGROUND

Passengers on the cruise ship Diamond Princess (DP), which departed Yokohama on 20 January 2020, were found to be infected with the new coronavirus after arrival in Hong Kong. Passengers and crew were not allowed to disembark, instead being quarantined on board; an onboard pandemic resulted. Many passengers were elderly and in need of medications; pharmacists and other professionals, including the author, were assigned to provide medical support (the author participated on two occasions). Many passengers were not Japanese nationals; those who required medicines not sold in Japan received analogs of medicines that are sold in Japan. Pharmacists were required to complete medication guidance documents (in English). The author considered that by using this experience as teaching material, pharmacy students would not only learn English but also become educated in terms of drug therapy.

METHOD

The author created an exercise for second-year students at Teikyo University in which they were required to provide real-world medical support. The educational effects were measured by analyzing the answers to questionnaires completed before and after the exercise and 'Impressions of the exercise' homework.

RESULTS

Using real emergency events as a teaching tool enhanced students' motivation to learn English and pursue professional pharmacy education (the latter was scheduled to begin in earnest in the third year). At that time, the new coronavirus was poorly understood. The author's experiences taught students that medical workers are educated to offer care even when they are at risk of infection. Translation software (a form of artificial intelligence [AI]) was used to create medication guidance documents in English. The students learnt that if AI translations, i.e., medication guidance documents in English, were accepted at face value, they would be held responsible if the documents were in error.

CONCLUSION

By both listening to the author's lecture on a real-world medical support situation and completing an assignment, students learned many things that are difficult to teach via lectures alone, including the dangers arising when using AI technology in clinical settings and the mindset of medical professionals.

High-Lethality Precision-Guided Nanomissile for Broad-Spectrum Virucidal and Anti-Inflammatory Therapy

Viral infection, especially the past SARS-CoV-2 pandemic, has posed severe threat toward globalized healthcare, whereas vaccine and drug development can hardly keep up with the rate of virus mutation and resistance. In severe COVID-19 patients, the virus triggers a cytokine storm marked by excessive pro-inflammatory cytokine release, resulting in acute respiratory distress syndrome (ARDS). Therefore, a comprehensive strategy for viral neutralization and inflammation suppression is highly demanded. Herein, we designed a high-lethality precision-guided nanomissile for broad-spectrum virucidal and anti-inflammatory therapy. The nanomissile was a nanoscale molecularly imprinted polymer (nanoMIP) harboring hypervalent mannose-binding cavities and loaded with a magnetocaloric core and photothermal dye ICG. It demonstrated an ultrafast heating rate, increasing from 25.2 to 55.9 °C within 60 s under alternating magnetic field (AMF) and near-infrared (NIR) laser irradiation. In addition, the nanomissile exhibited a unique double-punch mechanism, being capable of targeting not only the conserved high-mannose glycans of SARS-CoV-2, HIV-1, LASV, and PDCoV with Kd values reaching 10-10 M but also heat-inactivating the virions right away. Beyond this, it also exhibited significant anti-inflammatory and immunomodulatory properties. In the mouse model, the nanomissile exerted outstanding therapeutic and prophylactic effects while inhibiting virus replication and protecting lung injury. Thus, this potently broad-spectrum virucidal strategy opens a new access to eradicating viral infectivity and inflammatory storm suspension.

Anxiety, depression, and their associations with COVID-19-related knowledge, attitudes, and practices among healthcare professionals: a multinational cross-sectional survey

OBJECTIVE

To investigate the levels of anxiety and depression (A&D) and the association with knowledge, attitudes, and practices among healthcare professionals (HCPs) in Taiwan, Indonesia, and Vietnam.

METHODS

A multinational cross-sectional survey was performed to collect data from 3,556 HCPs through online platforms. The Likert scale questionnaire covered sociodemographic factors, work-related information, and COVID-19-related domains, including knowledge, attitudes, practices, working conditions and availability of personal protective equipment, changes in work and life routines due to the COVID-19 pandemic, and experiences of A&D. Multiple logistic regression models were used to evaluate the potential impact of the aforementioned domains on the levels of A&D across and between countries.

RESULTS

Distinct A&D profiles emerged among the three countries. Taiwan exhibited higher A&D scores (average 2.31) than Vietnam (1.61) and Indonesia (1.93) (p < 0.001). Taiwan also showed elevated knowledge and attitudes scores. Consistent patterns were observed in responses on practices, working conditions, and pandemic impact on daily routines. Multivariate analysis showed that higher knowledge and attitudes scores were significantly associated with reduced A&D risk in Taiwan. Experiencing the greatest changes in work and daily routines was strongly linked to higher A&D risk, with adjusted odds ratios of 3.64 (95% CI: 1.41-9.45) in Indonesia, 4.13 (95% CI: 2.96-5.75) in Taiwan, and 5.14 (95% CI: 3.18-8.31) in Vietnam. Further analysis revealed that factors such as transportation, work dynamics, family time, dietary habits, and income level, but not leisure time, had varying impacts on A&D across the three countries.

CONCLUSION

A&D and COVID-19-related knowledge, attitudes, and practices vary across countries. Thus, personalized support mechanisms and interventions are needed to address the diverse needs of HCPs within specific policy and country contexts.

Growth hormone replacement therapy enhances humoral response to COVID-19 mRNA vaccination in patients with adult-onset growth hormone deficiency

PURPOSE

Given the established link between GH/insulin-like growth factor 1 (IGF-1) deficiency and severe COVID-19 outcomes, this research seeks to determine whether GH therapy can enhance vaccine efficacy in patients with adult-onset growth hormone deficiency (aGHD).

METHODS

We conducted an observational retrospective study involving two groups: a cohort of 10 patients (8 females, 2 males) with obesity and aGHD who initiated recombinant GH replacement therapy at a standard dose of 0.1 mg/day six months to one year before their first vaccine dose, and a matched control group of 7 patients (5 females, 2 males) with aGHD who had not started GH treatment. Both groups were matched for age, gender, and body mass index (BMI) to ensure comparability. Blood samples were collected 3 to 6 months after the third booster dose of the COVID-19 vaccine (BNT162b2, Pfizer-BioNTech) and analyzed for anti-SARS-CoV-2 antibodies using a commercially available assay.

RESULTS

The GH-treated group exhibited a significantly greater humoral response compared to the untreated group, with a mean antibody titer of 19,122.1 ± 7,736.84 U/mL versus 9,539.14 ± 5,408.90 U/mL in the control group (p = 0.01). Multivariate regression analysis revealed that GH replacement therapy was the only statistically significant predictor of vaccine response, while factors such as male sex, age, and visceral adipose tissue showed negative correlations that did not reach significance.

CONCLUSION

Our findings suggest that GH replacement therapy may enhance the immune response to COVID-19 vaccination in patients with aGHD, potentially improving their overall metabolic health and immune function.

Prognostic factors of disease progression in patients with mild-to-moderate COVID-19 on early remdesivir treatment in Taiwan

BACKGROUND

An early 3-day course of remdesivir treatment was recommended for high risk patients with mild-to-moderate COVID-19. We investigated the prognostic factors of disease progression and mortality in patients with mild-to-moderate COVID-19 on early remdesivir treatment in Taiwan.

METHODS

Adult patients with mild-to-moderate COVID-19 treated with a 3-day course of remdesivir at Taipei Veterans General Hospital from April-July 2022 were identified. The main outcomes were 14-day disease progression (defined as increased oxygen requirement compared with the baseline condition or mortality) and 28-day mortality. Cox regression model was used to identify independent variables associated with poor outcomes.

RESULTS

Among the 342 patients on early remdesivir treatment, 41 patients (12 %) had 14-day disease progression, and 6 patients (1.8 %) died within 28 days. Seventy-nine patients (23.1 %) did not receive COVID-19 vaccine before the diagnosis of COVID-19. Charlson Comorbidity Index (CCI) ≥ 7 was the only independent factor associated with 14-day disease progression, and nosocomial COVID-19, initial neutrophil-to-lymphocyte ratio, and C-reactive protein (CRP) > 10 mg/dL were independent factors associated with 28-day mortality. In 231 patients (67.5 %) administered at least two doses of COVID-19 vaccine, 26 patients (11.3 %) had 14-day disease progression, and 5 patients (2.2 %) died within 28 days. CCI score ≥ 7 was the only independent factor for 14-day disease progression, and CRP level > 10 mg/dL was the independent factor associated with 28-day mortality.

CONCLUSIONS

Multiple comorbidities and nosocomial COVID-19 predisposed these patients to poor outcomes. Therefore, infection prevention and control measures are important in the fight against COVID-19.

The Impact of Omicron-related Stress on Mental Health in the General Population of China

BACKGROUND

Outbreaks of infectious disease represent unique stressors for the general population. In this study, we investigated the prevalence of mental health symptoms and associated risk factors in the general population of China during the Omicron wave.

METHODS

We conducted a cross-sectional and large sample online survey during the surge of Omicron cases between 17 December 2022 and 8 January 2023 among Chinese citizens. Then we assessed the prevalence of symptoms of anxiety, depression, insomnia, acute stress disorder, and resilience levels, in the general population of China during the Omicron pandemic by utilizing the coronavirus disease 2019 (COVID-19) anxiety scale (CAS), the Center for Epidemiologic Studies Depression Scale (CES-D), the Insomnia Severity Index scale (ISI), the Stanford Acute Stress Reaction Questionnaire (SASRQ), and the Connor-Davidson Resilience Scale (CD-RISC). Multivariate logistic regression analyses were used to identify demographic and Omicron-related risk factors.

RESULTS

In total, 2800 respondents across 32 provinces and autonomous regions on the Chinese mainland participated in this survey; 1133 (40.5%) were male, and 1860 (66.4%) were 40 years-of-age or younger. The prevalence of anxiety, depression, insomnia, and acute stress disorder was 52%, 58.3%, 45.2%, and 34.8%, respectively. After adjustment for covariates, female gender, a younger age, being unmarried, low income, and a non-medical post were all associated with mental health problems. During the course of infection, participants had a higher risk of developing symptoms of anxiety (odds ratio [OR]: 1.27; 95% confidence interval [CI]: 1.03-1.57; p = 0.028), depression (OR: 1.76; 95% CI: 1.44-2.16; p < 0.001), insomnia (OR: 1.95; 95% CI: 1.57-2.42, p < 0.001) and acute stress disorder (OR: 1.56; 95% CI: 1.25-1.93, p = 0.001). In addition, we found that a lower resilience among participants was associated with a higher risk of anxiety, depression, insomnia, and acute stress disorder (p < 0.001).

CONCLUSION

Omicron-related stress had a profound effect on the mental health of the general population of China, especially among those infected during the course of coronavirus disease 2019 (COVID-19) and with lower resilience. Our findings suggest that mental health can be improved during a pandemic by increasing resilience.

A SARS-CoV and SARS-CoV-2 RBD Heterodimer Vaccine Candidate

The continuous evolution of SARS-CoV-2 through accumulating mutations, combined with the persistent risk of zoonotic sarbecovirus transmission events, highlights the critical demand for broadly protective vaccines. Building on our previous findings that a heterodimeric receptor-binding domain (RBD) design substantially improves cross-reactive immunogenicity in vaccine candidates, we propose this strategy as a foundation for developing pan-sarbecovirus vaccines with cross-neutralizing capacity against diverse and emerging variants. In this study, we developed a sarbecovirus immunogen, utilizing a heterodimeric strategy incorporating the RBDs from both SARS-CoV and SARS-CoV-2. Pseudovirus neutralization assays revealed that mice immunized with the SARS-CoV-2 prototype (PT)-SARS-CoV heterodimer (PT-SARS) developed 39.9- to 305.6-fold higher neutralizing antibody (NAb) titers against SARS-CoV-2 sub-variants compared to the SARS-CoV RBD homodimer (SARS-SARS). Furthermore, PT-SARS elicited 17.6- and 31.2-fold enhanced neutralization against WIV1 and SARS-CoV, respectively, relative to the SARS-CoV-2 PT homodimer (PT-PT). To address evolving Omicron sub-variants, we further updated BA.1-SARS and BA.2-SARS immunogens. Notably, BA.2-SARS exhibited a 6.2-fold increase in neutralizing potency against BA.2.86 compared to PT-SARS. Crucially, the heterodimeric immunogen induced balanced and broadly reactive NAbs against multiple sarbecoviruses, including RaTG13, Pangolin GD, SARS-CoV, and SARS-CoV-2 variants/sub-variants, demonstrating its potential as a sarbecovirus immunogen candidate.

Challenges to Lifestyle Medicine for Type 2 Diabetes in Iran: A Synoptic Review

Type 2 diabetes (T2D) is a major public health issue in Iran. The principal context for T2D management is the prevention of cardiovascular disease development and progression. These preventive strategies can be enhanced with routine implementation of comprehensive lifestyle modification, guideline-directed medical therapies, and creation of infrastructure that considers social determinants of health, ethnocultural variables, and financial challenges. In this synoptic review, scientific evidence sourced from Iran is analyzed to identify tactics to optimize the lifestyle medicine component of T2D care in Iran. Important evidence-based factors gleaned from the literature were curated into 9 categories: self-care, dietary adherence, mental health, self-comparison, transcultural adaptation, family support and community engagement, physical activity, the global pandemic, and service delivery. These categories were then assigned to 1 of 4 a priori aspects challenging diabetes care in Iran: behavioral factors, belief system, drivers, and implementation. By codifying discussion points and individual tactics, the improvement and optimization of T2D care in Iran can be facilitated. This reductionist model of approaching lifestyle medicine and complex chronic disease such as T2D can be applied to other ethnocultural populations.

Mental health of persons with disabilities during the COVID-19 pandemic in Bangladesh

BACKGROUND

The COVID-19 pandemic has impacted the mental health of people across the world, including those with disabilities in Bangladesh. However, very little research exists that has explored the mental health problems experienced by persons with disabilities in rural and urban areas of Bangladesh. This study aimed to investigate the prevalence and associated factors of common mental health problems in persons with disabilities in rural and urban areas of Bangladesh.

METHODS

A cross-sectional survey using the Bangla Depression Anxiety Stress Scale-21 (BDASS-21) with sociodemographic was conducted among 950 participants with varying types of disabilities in Dhaka, Narayanganj, and Gazipur. Descriptive and inferential statistical analyses were used to measure the effects.

RESULTS

The prevalence of moderate to extremely severe depression, anxiety, and stress among participants was 67.6%, 72.6%, and 49.5%, respectively. Urban participants exhibited significantly higher levels of depression (76.6% in Dhaka), anxiety (86.1% in Dhaka), and stress (32.1% in Dhaka) compared to their rural counterparts (depression: 86.16%, anxiety: 91.07%, stress: 97.77% in Gazipur). Gender differences were observed in anxiety, with females reporting higher anxiety levels than males (p<0.05). Age and geographical location were significantly associated with stress (p<0.042 and p<0.001, respectively), with those reporting higher anxiety also experiencing greater stress (p<0.001). Specific disabilities, such as visual disabilities, were linked to higher stress levels, while depression and anxiety did not show significant associations with demographic factors or disability type.

CONCLUSION

Results highlight the prevalence of common mental health problems among persons with disabilities in Bangladesh. The findings can contribute to the development of appropriate public health intervention plans taking into consideration persons with disabilities, especially during emergencies.

Acute type A aortic dissection patients undergoing surgical repair during the COVID-19 pandemic

BACKGROUND

Acute type A aortic dissection (ATAAD) is a deadly form of acute aortic syndrome which necessitates emergency surgical repair. Coronavirus disease-19 (COVID-19) pandemic has caused a significant impact on surgery globally. The influence of the COVID-19 pandemic on ATAAD patients undergoing surgical repair remains undetermined.

METHODS

We conducted a systematic review and meta-analysis of studies comparing ATAAD patients undergoing aortic surgery before versus during the COVID-19 pandemic and literature review of published cases reporting COVID-19 patients undergoing surgical repair for ATAAD. PubMed, China National Knowledge Infrastructure, VIP, WANFANG, and SinoMed databases were searched for relevant studies and case reports till January 21st, 2023, and the database search was updated on January 3rd, 2024. Meta-analysis was performed by utilizing RevMan. Pooled odds ratio (OR) and 95% confidence interval (CI) were estimated for dichotomous data, and weighted mean difference (WMD) and 95% CI for continuous data, respectively. All P-values were 2-sided and statistical significance was defined as P < .05.

RESULTS

Meta-analysis of 5 included studies comparing ATAAD patients undergoing aortic surgery before versus during the COVID-19 pandemic demonstrated that, the patients in Group During-Pandemic (DP) were older than those in Group Before-Pandemic (BP; P = .005), and the body mass index of the patients in Group DP was lower than that of the patients in Group BP (P = .002), more patients in Group DP were smokers (P = .02). Meta-analysis also showed that, either the composite incidence of mortality and morbidities or individual morbidity was comparable between 2 groups, except that more patients in Group DP developed pneumonia (P = .05). Literature reviews of 24 published cases reporting COVID-19 patients undergoing surgical repair for ATAAD demonstrated that, twenty (83.3%) patients recovered well after aortic surgery and were finally discharged from hospital. Unfortunately, 4 patients died postoperatively, 3 due to multiple organ failure and one due to respiratory failure (RF). Reported postoperative complications included hypoxia, endotracheal re-intubation, RF, renal failure, coagulopathy, fever, multi-organ failure and shock.

CONCLUSION

The hospitalized outcomes of ATAAD patients undergoing surgical repair before versus during the COVID-19 were mostly comparable. ATAAD patients with concomitant COVID-19 infection who underwent emergent surgical repair had a high risk of mortality and morbidities.

Healthcare utilization among Japanese older adults during later stage of prolonged pandemic

This study examines healthcare utilization patterns among Japan's older population (aged 75 and above) during a prolonged public health emergency, focusing on the later phase of the COVID-19 pandemic (November 2021-September 2022). This period was characterized by the Omicron variant, widespread vaccination coverage, and adapted public health measures. Using a comprehensive dataset of 189,841,257 medical claims linked with income tax records, we analyze how healthcare utilization correlates with public health measures, pandemic severity, and income levels. Our findings reveal distinct utilization patterns: moderate decreases in healthcare visits during periods of public health measures, with the association between pandemic severity and healthcare use varying based on whether these measures are in place. Despite fluctuations in visit frequency, healthcare costs remain stable, indicating consistent service intensity. While income-related differences in general healthcare access are modest, dental care shows more pronounced socioeconomic variations. These patterns suggest a transition from initial widespread healthcare avoidance to more stable healthcare engagement, indicating adaptation to prolonged crisis conditions. Our findings provide insights for maintaining healthcare access during extended public health emergencies, particularly in aging societies where balancing healthcare needs with public health measures is crucial.

Molecular epidemiological surveillance of respiratory syncytial virus infection in Myanmar from 2019 to 2023

To evaluate genetic changes in respiratory syncytial virus (RSV) between 2019 and 2023, we analyzed RSV strains from Myanmar before and after the COVID- 19 pandemic. Real-time polymerase chain reaction (RT-PCR) positive samples from children presenting with acute respiratory infections at outpatient clinics in Yangon were sequenced to determine the genotype. Phylogenetic and molecular evolutionary analyses were conducted using the Bayesian Markov Chain Monte Carlo method to construct the time-scale Maximum Clade Credibility tree. Of 1127 samples, 104 (9.2%) RSV-A and 233 (20.7%) RSV-B were positive by RT-PCR. There was an absence of a notable epidemic in 2020, a temporal shift with a surge of RSV-A in the 2021 outbreak, a lack of expected cases in 2022 and a substantial resurgence of RSV-B in 2023. The genotype of RSV-A was mainly A.D.3 lineage through the study period, while RSV-B were B.D.4.1.1 and B.D.E.1. RSV-A showed that the same lineage persisted within Myanmar throughout the pandemic, leading to a large outbreak post-COVID. In contrast, RSV-B strains appear to have temporarily disappeared during the pandemic, but subsequently, globally circulating strains likely entered Myanmar, resulting in a major outbreak in 2023. The estimated evolutionary rate at the G-ectodomain for RSV-A was 7.76 × 10⁻³ and RSV-B was 5.67 × 10⁻³ substitutions/site/year. Strengthening genomic surveillance will likely support comparisons of circulating strains with those in other countries and facilitate the introduction of vaccines and other interventions.

Long COVID and Associated Factors Among Chinese Residents Aged 16 Years and Older in Canada: A Cross-Sectional Online Study

As the COVID-19 pandemic evolved, long COVID emerged as a significant threat to public health, characterized by one or more persistent symptoms impacting organ systems beyond 12 weeks of infection. Informative research has been derived from assessments of long COVID among the Chinese populace. However, none of these studies considered the COVID-19 experience of Chinese residents in Canada. Objectives: We aimed to fill this literature gap by delineating the long COVID experience, prevalence, and associated factors among a sample of Chinese residing in Canada during the pandemic. Methods: The present study employed a cross-sectional online survey questionnaire distributed to a sample of Canadian Chinese using a convenience sampling procedure from 22 December 2022 to 15 February 2023. Respondents were probed for sociodemographic background and health-, COVID-, and vaccine-related characteristics. Logistic LASSO regression was used for model building, and multivariate logistic regression was used to identify factors associated with developing long COVID. Results: Among 491 eligible participants, 63 (12.83%) reported experiencing long COVID with a mean duration of 5.31 (95% CI: 4.06-6.57) months and major symptoms including difficulty concentrating (21.67%), pain/discomfort (15.00%), as well as anxiety/depression (8.33%). Our final model identified significant associations between long COVID and two or more COVID-19 infections (OR = 23.725, 95% CI: 5.098-110.398, p < 0.0001), very severe/severe symptoms (OR = 3.177, 95% CI: 1.160-8.702, p = 0.0246), over-the-counter medicine (OR = 2.473, 95% CI: 1.035-5.909, p = 0.0416), and traditional Chinese medicine (OR = 8.259, 95% CI: 3.016-22.620, p < 0.0001). Further, we identified a significant protective effect of very good/good health status (OR = 0.247, 95% CI: 0.112-0.544, p = 0.0005). Conclusions: Long COVID effected a notable proportion of Canadian Chinese for a prolonged period during the COVID-19 pandemic. Our findings underscore the importance of preexisting health status and reinfection prevention when managing long COVID. Moreover, our work indicates an association between using over-the-counter medicine or traditional Chinese medicine and long COVID experience among Canadian Chinese.

Impact of vitamin D levels on mortality in older covid-19 vaccinated patients

BACKGROUND

Vitamin D plays a key role in regulating the immune system and vaccine response, and hypovitaminosis D is a known risk factor for mortality. However, its potential influence on mortality in SARS-CoV-2 vaccinated older adults remains underexplored. This study aims to examine survival differences between unvaccinated and vaccinated older adults with varying vitamin D levels, and to assess the impact of vitamin D on mortality.

METHODS

We recruited patients aged 65 and over from the Geriatrics Unit of Azienda Ospedale - Università Padova. Clinical, pharmacological data, including vaccination status and vitamin D levels, were collected at admission, alongside mortality data 12 months post-hospitalization. Participants were divided into three groups: unvaccinated, vaccinated with vitamin D levels of 25-50 nmol/L, and vaccinated with levels > 50 nmol/L.

RESULTS

A total of 126 participants were included (56% women, mean age 83 years). No significant differences were found in COVID-19 severity among the three groups. After 12 months, 24 deaths were recorded: 17% in unvaccinated, 19% in vaccinated with low vitamin D, and 20% in vaccinated with high vitamin D (p = 0.94). Kaplan-Meier curves showed that mortality risk for vaccinated individuals with low vitamin D was similar to unvaccinated patients but significantly higher than vaccinated individuals with high vitamin D (p = 0.04). Vitamin D levels of 25-50 nmol/L were associated with a threefold increased risk of 12-month mortality (HR: 3.79, p < 0.001).

CONCLUSIONS

Vitamin D levels can impact mortality in older vaccinated individuals. Early correction of vitamin D deficiency could potentially enhance outcomes.

The impact of insulin requirement on mortality and morbidity in non-diabetic covid-19 patients in the intensive care unit: A retrospective, observational study

BACKGROUND

COVID-19 ranges from asymptomatic cases to severe disease with high mortality. Corticosteroids are crucial in treatment, reducing mortality and morbidity. However, the use of corticosteroids poses additional challenges in maintaining glycemic control in COVID-19 patients This study aims to eva-luate the impact of insulin requirement on mortality and morbidity in non-diabetic ICU patients and investigate its correlation with disease severity.

METHODS

This retrospective cohort study included non-diabetic COVID-19 patients aged ≥ 18 years admitted to the ICU of Prof. Dr. Cemil Taşcıoğlu City Hospital (Turkey) between September 1, 2020, and May 31, 2021. Patients requiring ≥ 24 h of insulin therapy were compared with those who did not need insulin. Data on demographics, severity scores (SOFA, APACHE II, SAPS II), insulin initiation and duration, corticosteroid therapy, mechanical ventilation, antiviral and immunomodulatory treatments, laboratory markers, and infection parameters were analyzed. Mortality and incidence of new-onset diabetes mellitus within the first six months post-discharge were assessed. Statistical analyses were performed using SPSS v22.0, with p < 0.05 considered statistically significant.

RESULTS

Patients with insulin requirements had higher SOFA (p = 0.001), APACHE II (p < 0.001), and SAPS II (p = 0.041) scores, along with increased mechanical ventilation duration (p < 0.001). While corticosteroid type had no effect, > 1 mg/kg/day methylprednisolone or equivalent dexamethasone significantly increased insulin demand (p = 0.002). Among laboratory markers, only peak CRP levels were significantly higher in insulin-requiring patients (p = 0.001). ICU and total hospital stays were significantly longer in the insulin group (p < 0.001). Although in-hospital mortality was similar, 6-month mortality was significantly higher in insulin-requiring patients (p = 0.022). New-onset DM rates were 4.2% in the non-insulin group vs. 31.1% in the insulin group (p = 0.001).

CONCLUSIONS

Insulin requirement in non-diabetic COVID-19 ICU patients is a predictor of 6-month mortality. High-dose corticosteroids exacerbate glycemic dysregulation, increasing insulin needs. SARS-CoV-2-induced beta-cell damage and hyperinflammation-related stress hyperglycemia elevate the risk of post-discharge DM. Close monitoring and diabetes screening are essential in this population.

A comparative study of deterministic and stochastic computational modeling approaches for analyzing and optimizing COVID-19 control

This paper presents a comparative analysis of deterministic and stochastic computational modeling approaches for the optimal control of COVID-19. We formulate a compartmental epidemic model with perturbation by white noise that incorporates various factors influencing disease transmission. By incorporating stochastic effects, the model accounts for uncertainties inherent in real-world epidemic data. We establish the mathematical properties of the model, such as well-posedness and the existence of stationary distributions, which are crucial for understanding long-term epidemic dynamics. Moreover, the study presents an optimal control strategies to mitigate the epidemic's impact, both in deterministic and stochastic sceneries. Reported data from Algeria are used to parameterize the model, ensuring its relevance and applicability to practical satiation. Through numerical simulations, the study provides insights into the effectiveness of different control measures in managing COVID-19 outbreaks. This research contributes to advancing our understanding of epidemic dynamics and informs decision-making processes for epidemic controlling interventions.

Non-healthcare system interventions and COVID-19 daily cases: a multilevel time series analysis

BACKGROUND

The global COVID-19 pandemic has significantly impacted public health and socio-economic development worldwide. This study aims to investigate the effects of non-healthcare system interventions on the daily new cases of COVID-19 from January 2020 to October 2022.

METHODS

With the aid of multilevel approach, we identified income group, region and country as stratification factors that affect the number of COVID-19 daily new cases. Data on COVID-19 cases collected by Johns Hopkins University were used, and policy implementation details were recorded through the Oxford COVID-19 Government Response Tracker dataset. To analyze the effects of national, regional, and income group factors on the number of daily new COVID-19 cases, we implemented three multilevel sequential mixed-effects models and applied restricted maximum likelihood to estimate the variance of random effects.

RESULTS

Our results indicate a correlation between income group and the rise in intercepts of random effects in the multilevel sequential mixed-effects models. High-income countries recorded the highest intercept at 713.26, while low-income countries showed the lowest at -313.79. Under the influence of policies, the implementation of "Canceling public events" and "International travel restrictions" has been shown to significantly reduce the daily number of new COVID-19 cases. In contrast, "Restrictions on gatherings" appear to have the opposite effect, potentially leading to an increase in daily new COVID-19 cases.

CONCLUSIONS

In designing epidemic control policies, due consideration should be given to factors such as income group, as well as medical, demographic, and social differences among nations influenced by economic factors. In policy-making, policymakers should pay greater attention to policy implementation and people's responses, in order to maximize the effectiveness and adherence of such policies.

Experiences, challenges, and training reflections of nurses in isolation wards during different pandemic prevention policy periods: a qualitative study

BACKGROUND

During the pandemic, China's control policies shifted from nationwide restrictions to precise control and monitoring, which ended with complete relaxation, presenting unique challenges for nurses. Existing qualitative studies mostly focused on the experiences of frontline nurses in the early stages of the pandemic, but they overlooked the dynamic nature of the role changes and adaptation processes as the pandemic evolved. In-depth research into nurses' experiences across different control phases is crucial for guiding future training to improve preparedness and policy enhancements.

OBJECTIVE

To explore the experiences and challenges faced by frontline nurses in China during different phases of pandemic control policies. It also evaluates their training, reflects on the inadequacies of the training, and discusses how these experiences can inform future training programs while offering recommendations to enhance future emergency preparedness.

METHODS

This study employed a qualitative descriptive design to explore the experiences and insights of nurses during the pandemic, as well as their attitudes toward training. Twenty-four frontline nurses from various hospitals in China were recruited using snowball sampling for in-depth interviews, which spanned two months. Data analysis was conducted using Giorgi's phenomenological approach, involving coding and theme extraction.

RESULTS

From a content analysis perspective, five main themes were extracted from different stages of control policies during the pandemic: (1) Nurses' feelings and responses: including early psychological stress and physical discomfort during the pandemic, adaptation and conflicts in isolation management during the rebound period, and later medical resource shortages. (2) Work achievements: covering a sense of mission, personal growth, and recognition. (3) Difficulties and challenges encountered: including initial workflow issues, resource shortages, critical care management gaps, communication barriers during the rebound period, and a decline in staff morale. (4) Training issues: rushed early training, limited content, lack of process and details during the rebound period, inconsistent standards, and lack of enthusiasm for participation. (5) Training improvement recommendations: suggesting an emphasis on training content, reasonable scheduling of training time, various forms of training, multiple assessment methods, and establishment of human resource reserves.

CONCLUSION

These findings reveal the challenges faced by frontline nurses during different phases of the pandemic, emphasizing the necessity of comprehensive and systematic nurse training programs. Recommendations include regularly updating training content, enhancing communication and psychological intervention training, diversifying training formats, establishing a mechanism for continuous learning, and exploring personalized training plans to improve nurses' preparedness in future public health crises.

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.

Impact of SARS-CoV-2 Infection on the Outcomes of Trauma Patients at a Level I Trauma Center: An Ambispective Observational Study

INTRODUCTION

Trauma remained a leading cause of hospital admissions even during the COVID-19 pandemic. Trauma and surgical interventions are known to impair the patient's immune function. Clinically, some asymptomatic COVID-19 patients experienced rapid deterioration following surgery. Surgeons and anesthesiologists need to be aware that acute lung injury caused by COVID-19 could be present preoperatively or may worsen postoperatively. Hence, an ambispective observational study was planned to assess the impact of severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection on trauma patient outcomes.

AIMS AND OBJECTIVES

This study aims to evaluate the impact of SARS-CoV-2 infection on the outcomes of trauma patients at a level I trauma center.

MATERIALS AND METHODS

This ambispective observational study was conducted at a level 1 trauma center and included patients admitted under the trauma surgery service in the COVID-19 facility. Their outcomes were compared with those of patients admitted to the non-COVID-19 facility from March 2020 to March 2022.

RESULTS

A total of 2,017 patients were admitted under the Division of Trauma Surgery and Critical Care from March 2020 to March 2022. The mean duration of intercostal drainage (ICD) was significantly longer in SARS-CoV-2-positive trauma patients (7.03 ± 3.69 days) compared to SARS-CoV-2-negative trauma patients (5.28 ± 2.75). Acute respiratory distress syndrome (ARDS) was also more common among SARS-CoV-2-positive trauma patients. Additionally, these patients had a longer hospital stay. Notably, SARS-CoV-2-positive trauma patients who died had a significantly lower average injury severity score (ISS) compared to SARS-CoV-2-negative counterparts.

DISCUSSION

Although the average ISS was lower and the average trauma and injury severity score (TRISS) was higher in SARS-CoV-2-positive trauma patients who died compared to SARS-CoV-2-negative trauma patients, overall mortality rates were comparable between the two groups.

CONCLUSION

Trauma patients with concomitant SARS-CoV-2 infection had a longer duration of ICD, along with an increased incidence of chest infections and ARDS. A greater proportion of SARS-CoV-2-positive trauma patients required ventilatory support. The mortality observed in SARS-CoV-2-positive trauma patients is likely attributed to the concomitant SARS-CoV-2 infection.

Target-driven functionalized DNA hydrogel capillary sensor for SARS-CoV-2 dual-mode detection

Coronavirus disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused secondary pandemic, which still poses a serious threat to physical health and economic development. Herein, the target-driven functionalized DNA hydrogel capillary sensor based on cascade signal amplification and carbon coated cobalt manganese modified by prussian blue and platinum nanoparticles (MnCo@C-Pt-PB NPs) has been successfully developed for dual-mode detection of SARS-CoV-2. The cascade signal amplification triggered by target RNA causes the permeability of the DNA hydrogel loaded in the capillary to be destroyed, thereby releasing the embedded MnCo@C-Pt-PB NPs as signal molecules into 3,3',5,5'-tetramethylbenzidine/hydrogen peroxide (TMB/H2O2) solution under the driving of capillarity. The colorless TMB is then catalyzed to blue oxidation products (oxTMB) due to peroxidase-like activity of MnCo@C-Pt-PB NPs, and MnCo@C-Pt-PB NPs and oxTMB with photothermal properties synergistically increase the system temperature under near-infrared irradiation, which are recorded by portable devices to achieve dual-mode detection. Signals intensity are proportional to the logarithm of T-RNA concentration in a wide detection range (100 aM-100 pM), with a detection limit of 100 aM. Moreover, the reliability of the developed method in oropharyngeal swabs samples has also been validated. The signal conversion and amplification function of functionalized DNA hydrogel enhances the convenience, sensitivity and versatility of the developed method, which is promising to be applied in environmental safety, molecular diagnostic assays and disease prevention.

The Effects of Fear of COVID-19 and Perceived Social Support on Postpartum Depression: A Path Analysis

RATIONALE

Postpartum depression is a significant health problem that negatively affects maternal and fetal health and should be carefully evaluated by health professionals in extraordinary situations such as disasters and pandemics. This study aimed to examine the effects of fear of COVID-19, perceived social support, and some socio-demographic and obstetric characteristics of women on the risk of postpartum depression during the pandemic period using path analysis.

METHODS

This cross-sectional study was conducted with 226 women over 18 years of age, literate, gave birth at term, were between 2 weeks and a year postpartum, could use smartphones, and had not had COVID-19. The data were collected using the instruments Personal Information Form, the Fear of COVID-19 Scale (FCV-19S), the Edinburgh Postnatal Depression Scale (EPDS), and the Multidimensional Scale of Perceived Social Support (MSPSS). Data were collected via online survey method between 14 November 2020 and 30 December 2020.

RESULTS

The prevalence of risk of postpartum depression was 35.8%. The mean FCV-19S score was 19.72 ± 6.75, the mean MSPSS score was 56.69 ± 17.49, and the mean EPDS score was 10.03 ± 6.21. Binary logistic regression analysis showed that risk factors associated with postpartum depression risk in postpartum women during the pandemic family type (OR: 0.316, p = 0.05), satisfaction with childbirth experience (OR: 5.907, p = 0.003), fear of COVID-19 (OR: 1.104, p < 0.001), and perceived social support (OR: 0.942, p < 0.001). According to the path analysis, the χ2/degree of freedom value of the model is 1.35 and GFI: 0.99, AGFI: 0.96, CFI: 0.98, RMSEA: 0.040, NFI: 0.94, NNFI: 0.93, SRMR: 0.041 for path analysis. Path analysis revealed that having a nuclear family (β = 1.33), perceived social support (β = -0.13), having a history of depression (β = 3.61), fear of COVID-19 (β = 0.14), and satisfaction with the birth experience (β = -2.56) had a direct negative effect on the risk of PPD during the pandemic.

CONCLUSION

The findings suggest that strengthening social support, helping her cope with the fear of COVID-19, having a good birth process, and reasonable evaluation of their mental health history can alleviate the risk of PPD during the pandemic period. On the other hand, our findings may guide the development of prevention and intervention approaches for factors that directly and indirectly affect women's PPD risk during the pandemic period.

Global, regional and national trends in incidence and mortality of pertussis from 1990 to 2021 and the comparison before and during COVID-19: A modelling analysis

BACKGROUND

Pertussis, a contagious respiratory disease, has seen a global decline in cases due to vaccination but has resurged because of waning immunity, with further impacts from the COVID-19 pandemic. This study aimed to assess the disease burden of pertussis worldwide from 1990 to 2021.

METHODS

Using the GBD 2021, we extracted age-standardized incidence rates (ASIR) and death rates (ASDR) of pertussis and analyzed the trends of them through calculating the estimated annual percentage change (EAPC) at global, regional and national levels from 1990 to 2021. Besides, we compared the EAPCs before and during the COVID-19 pandemic to explore the difference. Lastly, we investigated the association between age-standardized rates (ASR) and the socio-demographic index (SDI).

RESULTS

From 1990-2021, the global ASIR and ASDR of pertussis witnessed an annual decline of 2.57 % (95 %CI: 1.91-3.22 %) and 3.20 % (2.54-3.85 %) on average, respectively. During the COVID-19 pandemic, the ASR showed steep downward trends not only globally but also in diverse regions. Nevertheless, before the pandemic, Southern Sub-Sahara Africa witnessed upward trends in ASR, whose EAPCs were 0.85 % (0.67-1.02 %) for ASIR and 0.65 % (0.41-0.88 %) for ASDR. Additionally, a remarkable negative correlation was revealed between ASR and SDI (Regional level: r = -0.843; r = -0.885. National level: r = -0.621; r = -0.762. All P < 0.001.), corroborating with the observation that regions and countries with lower SDI bore the higher disease burden.

CONCLUSIONS

From 1990-2021, global burden of pertussis showed a downward trend, with significant drops during the COVID-19 pandemic. However, before the COVID-19, Southern Sub-Saharan Africa saw rising ASIR and ASDR, contrary to the majority. Besides, SDI was proved negatively correlated with ASR, indicating that low-SDI countries, especially in Sub-Saharan Africa, faced high disease burden, which highlighted the need for improving immunization, surveillance, and healthcare resource allocation to control pertussis effectively.

Molecular Basis of High-Blood-Pressure-Enhanced and High-Fever-Temperature-Weakened Receptor-Binding Domain/Peptidase Domain Binding: A Molecular Dynamics Simulation Study

The entry and infection of the Severe Acute Respiratory Syndrome Coronavirus 2 virus (SARS-CoV-2) involve recognition and binding of the receptor-binding domain (RBD) of the virus surface spike protein to the peptidase domain (PD) of the host cellular Angiotensin-Converting Enzyme-2 (ACE2) receptor. ACE2 is also involved in normal blood pressure control. An association between hypertension and COVID-19 severity and fatality is evident, but how hypertension predisposes patients diagnosed with COVID-19 to unfavorable outcomes remains unclear. High temperature early during SARS-CoV-2 infection impairs binding to human cells and retards viral progression. Low body temperature can prelude poor prognosis. In this study, all-atom molecular dynamics simulations were performed to examine the effects of high pressure and temperature on RBD/PD binding. A high blood pressure of 940 mmHg enhanced RBD/PD binding. A high temperature above 315 K significantly weakened RBD/PD binding, while a low temperature of 305 K enhanced binding. The curvature of the PD α1-helix and proximity of the PD β3β4-hairpin tip to the RBM motif affected the compactness of the binding interface and, hence, binding affinity. These findings provide novel insights into the underlying mechanisms by which hypertension predisposes patients to unfavorable outcomes in COVID-19 and how an initial high temperature retards viral progression.

Poly(3,4-ethylenedioxythiophene) Nanorod Arrays-Based Organic Electrochemical Transistor for SARS-CoV-2 Spike Protein Detection in Artificial Saliva

The outbreak and continued spread of coronavirus disease 2019 (COVID-19) have significantly threatened public health. Antibody testing is essential for infection diagnosis, seroepidemiological analysis, and vaccine evaluation. However, achieving convenient, fast, and accurate detection remains challenging in this prolonged battle. This study reports a highly sensitive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein detection platform based on organic electrochemical transistors (OECTs) for biosensing applications. We developed a nanostructured poly(3,4-ethylenedioxythiophene) (PEDOT) conductive polymer with the carboxylic acid functional group (PEDOTAc) for modifying specific antibodies on an OECT channel for the detection of the COVID-19 spike protein. The OECT device features a channel composed of a PEDOT:polystyrenesulfonate (PEDOT:PSS) bottom layer, with the upper layer decorated with PEDOTAc nanorod arrays via the oxidative polymerization and a trans-printing method. Our novel PEDOTAc nanorod array-based OECT device exhibits promising potential for future healthcare and point-of-care sensing due to its rapid response, high sensitivity, and high accuracy. Through optimization, we achieved specific detection of the SARS-CoV-2 spike protein within minutes, with a detectable region from 10 fM to 100 nM. These biosensors hold significant promise for use in the diagnosis and prognosis of COVID-19.

The impact of the COVID-19 pandemic on governmental hospitals performance indicators in city of Yazd, Iran: an interrupted time-series analysis

BACKGROUND

The Covid-19 pandemic stretched health systems globally including in Iran. Hospital demand and performance was affected both directly and indirectly as a result of the pandemic. Analyzing hospital indicators can provide insights to deal with the consequences and challenges related to various aspects of future pandemics.

OBJECTIVE

This study aimed to investigate the impact of the Covid-19 pandemic on key performance indicators of public hospitals in Iran.

METHODS

In this quasi-experimental study, we used time-series analysis to examine eight key indicators of hospital performance: number of outpatient visits, number of elective hospitalization, average length of stay, hospital mortality rate, number of surgeries, hospitalization rate, emergency visits, bed occupancy rate, and hospitals' revenue. Data were extracted from four public hospitals in Yazd at two time intervals, 15 months before and after the outbreak of COVID-19. Data were analysed using interrupted time series analysis models with STATA17.

RESULTS

Average length of stay (p = 0.02) and hospital mortality rate (p < 0.01) increased significantly following the outbreak of COVID-19, while the mean of other indicators such as number of outpatient visits (p < 0.01), number of elective hospitalization (p < 0.01), number of surgeries (p = 0.01), hospitalization rate (p < 0.01), emergency visits (p < 0.01) and bed occupancy rate (p < 0.01) decreased significantly. The Covid-19 pandemic had an immediately reverse significant impact on the level changes of "outpatient visits", "elective hospitalization", "hospitalization rate", "emergency visits" and "bed occupancy rate" indicators (p < 0.05). Although the trend of surgeries indicator was affected significantly (p = 0.01) after the covid-19 outbreak.

CONCLUSION

We showed significant changes in most hospital indicators after the Covid-19 pandemic, reflecting the effect of this pandemic on the performance of hospitals. Understanding the impact of a pandemic on hospital indicators is necessary for decision-makers to effectively plan an effective pandemic response and to inform resource allocation decisions.

Hollow Mesoporous Carbon Nanospheres/Ni Hybrids Aid in Metabolic Encoding for COVID-19 Recovery Assessment in Mothers and Fetuses

Metabolite analysis of body fluids is an advanced method for disease diagnosis and status assessment. Laser desorption/ionization-mass spectrometry (LDI-MS) has been widely employed for metabolic analysis due to the fast detection speed and simple sample pretreatment. Here, we designed and synthesized hollow mesoporous carbon nanospheres anchored with Ni (HMCSs/Ni) to simultaneously enhance the ionization and thermal desorption processes of the LDI process owing to their hollow and mesoporous structure, large surface area, and abundant Ni-N bonds. Based on HMCSs/Ni, we built an LDI-MS platform that can be used for metabolic information extraction and achieved the rapid detection (about seconds per sample) of metabolic fingerprints in trace serum samples (∼0.1 μL) without complicated preprocessing procedures. Then, we conducted serum metabolic screening in a cohort of COVID-19-recovered pregnant women. The optimized machine learning model could distinguish recovered pregnant women from uninfected pregnant women based on metabolic features with an AUC value of 0.901. In addition, the model indicates that maternal COVID-19 infection does not significantly affect the metabolic fingerprints of the fetuses. Overall, our work shows the prospect of HMCSs/Ni-assisted LDI-MS in disease recovery assessment and metabolite analysis.

Exploring Coronavirus Disease 2019 Risk Factors: A Text Network Analysis Approach

Background/Objectives: The coronavirus disease 2019 (COVID-19) pandemic has significantly affected global health, economies, and societies, necessitating a deeper understanding of the factors influencing its spread and severity. Methods: This study employed text network analysis to examine relationships among various risk factors associated with severe COVID-19. Analyzing a dataset of published studies from January 2020 to December 2021, this study identifies key determinants, including age, hypertension, and pre-existing health conditions, while uncovering their interconnections. Results: The analysis reveals five thematic clusters: biomedical, occupational, demographic, behavioral, and complication-related factors. Temporal trend analysis reveals distinct shifts in research focus over time. In early 2020, studies primarily addressed immediate clinical characteristics and acute complications of COVID-19. By mid-2021, research increasingly emphasized long COVID, highlighting its prolonged symptoms and impact on quality of life. Concurrently, vaccine efficacy became a dominant topic, with studies assessing protection rates against emerging viral variants, such as Alpha, Delta, and Omicron. This evolving landscape underscores the dynamic nature of COVID-19 research and the adaptation of public health strategies accordingly. Conclusions: These findings offer valuable insights for targeted public health interventions, emphasizing the need for tailored strategies to mitigate severe outcomes in high-risk groups. This study demonstrates the potential of text network analysis as a robust tool for synthesizing complex datasets and informing evidence-based decision-making in pandemic preparedness and response.

Genetic Analysis and Predictive Modeling of COVID-19 Severity in a Hospital-Based Patient Cohort

The COVID-19 pandemic has had a devastating impact, with more than 7 million deaths worldwide. Advanced age and comorbidities partially explain severe cases of the disease, but genetic factors also play a significant role. Genome-wide association studies (GWASs) have been instrumental in identifying loci associated with SARS-CoV-2 infection. Here, we report the results from a >820 K variant GWAS in a COVID-19 patient cohort from the hospitals associated with IIS Biobizkaia. We compared intensive care unit (ICU)-hospitalized patients with non-ICU-hospitalized patients. The GWAS was complemented with an integrated phenotype and genetic modeling analysis using HLA genotypes, a previously identified COVID-19 polygenic risk score (PRS) and clinical data. We identified four variants associated with COVID-19 severity with genome-wide significance (rs58027632 in KIF19; rs736962 in HTRA1; rs77927946 in DMBT1; and rs115020813 in LINC01283). In addition, we designed a multivariate predictive model including HLA, PRS and clinical data which displayed an area under the curve (AUC) value of 0.79. Our results combining human genetic information with clinical data may help to improve risk assessment for the development of a severe outcome of COVID-19.

Single- and multiple-dose pharmacokinetics and safety of the SARS-CoV-2 3CL protease inhibitor RAY1216: a phase 1 study in healthy participants

Coronavirus disease 2019, which leads to pneumonia, is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). RAY1216 is a 3C-like protease inhibitor that targets SARS-CoV-2. The aim of our study was to assess the pharmacokinetics (PK) and safety of RAY1216 in healthy volunteers. This was a randomized, placebo-controlled, double-blind study consisting of four components: a single ascending dose study, a drug-drug interaction study, a multiple ascending dose study, and a food-effect study. All participants were randomly assigned to receive either a single dose or multiple doses of RAY1216 or placebo. A total of 88 healthy adult participants (male-to-female ratio of 1:1) aged 18-50 years were enrolled. A total of 37 participants (42%) experienced at least one adverse event (AE). All AEs were mild or moderate and were resolved without additional treatment. The most commonly reported adverse drug reactions were hypertriglyceridemia, hyperuricemia, and elevated serum creatinine levels. RAY1216 was well-absorbed after administration with exposure increasing in a dose-dependent manner. Food appeared to increase exposure and delay the absorption of RAY1216. Ritonavir significantly inhibited drug metabolism, and increased drug exposure increased the associated safety risks. RAY1216 was found to be well tolerated and safe in healthy participants. On the basis of preclinical results, PK characteristics, and the safety profile of RAY1216, a dosage of 400 mg three times daily was selected, thereby establishing a foundation for future research and for the clinical application of RAY1216.CLINICAL TRIALSThis study is registered with ClinicalTrials.gov as NCT05829551.

Community's Educational Needs During the COVID-19 Pandemic: A Qualitative Study

Background

Due to its unknown nature, multifaceted symptoms, and rapid spread, the coronavirus has become a public health emergency, leading to international concerns. Therefore, this study aims to investigate the community's educational needs during the COVID-19 pandemic.

Materials and Methods

This qualitative research was conducted between 2020 and 2021 using a conventional content analysis approach. The research sample comprised 340 recorded calls from individuals who contacted the emergency hotline of Isfahan University of Medical Sciences during the COVID-19 pandemic to express their concerns and anxieties. Sampling was conducted randomly and purposively until data saturation was achieved. Additionally, Graneheim and Lundman's approach was utilized for data analysis.

Results

After analyzing the interviews, codes related to the reasons for contact were presented in five main categories, including awareness of the nature of the disease, awareness of preventive methods, awareness of diagnostic methods, awareness of treatment methods, and awareness of caring for high-risk groups and 15 subcategories.

Conclusions

The results of this study highlighted various concerns regarding the coronavirus disease during pandemic conditions, which can serve as a foundation for appropriate educational and counseling programs based on community needs during future infectious pandemics.

Association between confirmed COVID-19 cases at hospitals and SARS-CoV-2 levels in municipal wastewater during the pandemic and endemic phases

COVID-19 is now considered endemic in many countries. On May 8, 2023, Japan reclassified COVID-19 from a pandemic to an endemic status, shifting surveillance from universal to sentinel reporting and transitioning the testing and treatment cost of COVID-19 from public funding to individual health insurance coverage. Restrictions on movement, events, and business hours were lifted, potentially increasing cases and complicating tracking. Monitoring hospital cases remains essential to protect high-risk inpatients from nosocomial infections. In this study, 13,812 COVID-19 cases in 12 hospitals were analyzed and the results revealed a strong correlation between SARS-CoV-2 levels in municipal wastewater and weekly new cases during both the pandemic period (February 15, 2021 - February 26, 2023; Pearson's r = 0.8321) and the endemic period (May 8, 2023 - October 1, 2023; Pearson's r = 0.7501). SARS-CoV-2 RNA levels in wastewater from municipal catchment areas showed a stronger correlation with the number of COVID-19 cases at hospitals than did RNA levels in wastewater from the catchment area where the hospitals are located. The difference in correlations was more pronounced during the endemic period. During the endemic period, measurements of SARS-CoV-2 RNA levels in samples obtained from larger sewersheds may be more effective in capturing the overall trends of COVID-19 cases in a region. In other words, during the endemic period, municipal wastewater surveillance may reflect the number of COVID-19 cases in hospitals. Even for facilities that do not monitor SARS-CoV-2 in their own hospital wastewater, publicly available municipal wastewater data can be used to estimate the number of COVID-19 cases in hospitals. Furthermore, COVID-19 infection control measures within hospitals can be evaluated by comparing the number of nosocomial infection patients based on the concentration of SARS-CoV-2 in municipal wastewater.

Ocular Adverse Events Following Coronavirus Disease 2019 Infection: A Self-controlled Case Series Study from the Entire Korean Population

Purpose

This study aimed to assess the risk of ocular adverse events, including retinal artery occlusion (RAO), retinal vein occlusion (RVO), noninfectious uveitis (NIU), noninfectious scleritis (NIS), optic neuritis (ON), ischemic optic neuropathy (ION), and ocular motor cranial nerve palsy (OMCNP), after coronavirus disease 2019 (COVID-19) infection.

Design

Population-based self-controlled case series (SCCS).

Participants

The study included patients from the entire Korean population of 52 million who experienced incident RAO, RVO, anterior NIU, nonanterior NIU, NIS, ON, ION, or OMCNP between January 1, 2021, and October 29, 2022.

Methods

This nationwide SCCS utilized data from the Korea National Health Insurance Service and the Korea Disease Control and Prevention Agency. The risk period after infection was defined as up to 24 weeks after COVID-19 infection. Conditional Poisson regression was used to calculate the relative incidence rate ratios (IRRs) for RAO, RVO, anterior NIU, nonanterior NIU, NIS, ON, ION, and OMCNP during the designated risk periods.

Main Outcome Measures

The IRRs for RAO, RVO, anterior NIU, nonanterior NIU, NIS, ON, ION, and OMCNP during the risk periods.

Results

The study included 9336, 103 362, 201 010, 25 428, 23 744, 3026, 69 933, and 16 335 cases of incident RAO, RVO, anterior NIU, nonanterior NIU, NIS, ON, ION, and OMCNP, respectively. The IRRs (95% confidence interval) during the early risk period (1-8 weeks) were 0.94 (0.83-1.07), 1.01 (0.97-1.04), 1.00 (0.98-1.03), 0.96 (0.90-1.03), 1.00 (0.94-1.07), 0.97 (0.81-1.17), 0.97 (0.93-1.01), and 1.02 (0.94-1.11), respectively. In the late risk period (9-24 weeks), the IRRs were 1.02 (0.92-1.12), 1.01 (0.98-1.04), 1.01 (0.99-1.03), 1.02 (0.97-1.08), 1.02 (0.97-1.08), 0.99 (0.85-1.15), 1.02 (0.99-1.06), and 0.97 (0.90-1.03), respectively. Stratified analyses showed that in patients with a history of cerebro-cardiovascular disease, the risk of RAO increased during the late risk period, with an IRR (95% confidence interval) of 1.19 (1.02-1.40).

Conclusions

The risk of incident RVO, anterior NIU, nonanterior NIU, NIS, ON, ION, or OMCNP did not increase after COVID-19 infection. The risk of incident RAO increased only in individuals with preexisting cardio-cerebrovascular disease.

Financial Disclosures

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

"If I Stay Quiet, the Only Person That Gets Hurt Is Me": Anti-Asian Racism and the Mental Health of Chinese-Canadian Youth During the COVID-19 Pandemic

Background and PurposeDespite documented accounts of racial discrimination against Chinese communities during the COVID-19 pandemic, few studies have examined experiences of racism among Canadian youth. This qualitative study explored the experiences of Chinese-Canadian youth during the COVID-19 pandemic and their mental health.MethodsA qualitative descriptive research design, informed by Critical Race Theory (CRT), was used for this study. Data was collected using focus groups and image-based elicitation methods. Youth who self-identified as Chinese-Canadian, aged 18-24, and who experienced some account of self-defined racism were included. We analyzed the data using a coding system developed for this study and formulated key themes.ResultsOur analysis identified three themes: (I) Becoming racialized; (II) Learning the rules of racism; and (III) Effects of racism on mental health. We discuss findings in relation to the model minority stereotype, intersectionality of race and gender, and factors leading to a lack of support.ConclusionsThis study provides evidence that racism had immediate and prolonged effects on the mental health of Chinese-Canadian youth and their relationships with peers, family, and even strangers. Our research suggests the need for enhanced services for Chinese-Canadian youth and other groups experiencing racism.

Airborne fungal communities are more susceptible to anthropogenic activities than bacteria

Airborne microorganisms (AM) have significant environmental and health implications. Extensive studies have been conducted to investigate the factors influencing the composition and diversity of AM. However, the knowledge of AM with anthropogenic activities has not reach a consensus. In this study, we took advantage of the dramatic decline of outdoor anthropogenic activities resulting from COVID-19 lockdown to reveal their associations. We collected airborne particulate matter before and during the lockdown period in two cities. The results showed that it was fungal diversity and communities but not bacteria obviously different between pre-lockdown and lockdown samples, suggesting that airborne fungi were more susceptible to anthropogenic activities than bacteria. However, after the implementation of lockdown, the co-occurrence networks of both bacterial and fungal community became more complex, which might be due to the variation of microbial sources. Furthermore, Mantel test and correlation analysis showed that air pollutants also partly contributed to microbial alterations. Airborne fungal community was more affected by air pollutants than bacterial community. Notably, some human pathogens like Nigrospora and Arthrinium were negatively correlated with air pollutants. Overall, our study highlighted the more impacts of anthropogenic activities on airborne fungal community than bacterial community and advanced the understanding of associations between anthropogenic activities and AM.

A novel neutralizing antibody recognizing a conserved conformational epitope in PDCoV S1 protein and its therapeutic efficacy in piglets

Porcine deltacoronavirus (PDCoV) is an enteric pathogen that burdens the global pig industry and is a public health concern. The development of effective antiviral therapies is necessary for the prevention and control of PDCoV, yet to date, there are few studies on the therapeutic potential of PDCoV-neutralizing antibodies. Here, we investigate the therapeutic potential of a novel monoclonal antibody (mAb 4A6) which targets the PDCoV S1 protein and effectively neutralizes PDCoV, both pre- and post-attachment on cells, with IC50 values of 0.537 and 8.487 µg/mL, respectively. A phage-display peptide library was used to determine the epitope recognized by mAb 4A6, and two mimotopes, QYPVSYA (P1) and FPHWPTI (P2), were identified. KLH-P1 reacted with PDCoV-positive sera but failed to induce PDCoV-specific IgG and neutralizing antibodies in mice, suggesting P1 does not fully mimic the conformational epitope. Molecular docking and alanine scanning mutagenesis revealed that S461, P462, T463, E465, and Y467 on the S protein are essential for mAb 4A6 binding. Antibody therapy experiments in PDCoV-infected piglets showed that administering mAb 4A6 once or twice could delay the onset of diarrhea symptoms, reduce the severity of diarrhea, and decrease virus shedding. Taken together, our findings demonstrate that mAb 4A6 holds promise as a treatment against PDCoV, and the amino acids recognized by mAb 4A6 will be valuable for developing novel epitope-based vaccines or antiviral drugs.

IMPORTANCE

Porcine deltacoronavirus (PDCoV) is a novel swine enteropathogenic coronavirus that poses a potential threat to public health. Developing effective antiviral therapies is crucial for its prevention and control. Here, we demonstrated that mAb 4A6 shows promise as a treatment against PDCoV. Antibody therapy experiments conducted on PDCoV-infected piglets revealed that administering mAb 4A6 once or twice could delay the onset of diarrhea symptoms, reduce the severity of diarrhea, and decrease virus shedding. Furthermore, we characterized the conformational epitope (S461, P462, T463, E465, and Y467) recognized by mAb 4A6 through an integrated approach involving phage display peptide library, molecular docking, and alanine scanning mutagenesis. More importantly, mAb 4A6 exhibits a broad-spectrum neutralizing activity against different PDCoV strains. These findings indicate that mAb 4A6 has promising therapeutic value for PDCoV-infected piglets, and the identification of mAb 4A6 recognized epitope may provide a new idea for the identification of conformational epitopes.

The Omicron variant BA.2.86.1 of SARS- CoV-2 demonstrates an altered interaction network and dynamic features to enhance the interaction with the hACE2

The SARS-CoV-2 variant BA.2.86 (Omicron) has emerged with unique mutations that may increase its transmission and infectivity. This study investigates how these mutations alter the interaction network and dynamic properties of the Omicron receptor-binding domain (RBD) compared to the wild-type virus, focusing on its binding affinity to the human ACE2 (hACE2) receptor. Protein-protein docking and all-atom molecular dynamics simulations were used to analyze structural and dynamic differences. Despite the structural similarity, the Omicron variant exhibits a distinct interaction network with new residues such as Lys353 and Arg498 that significantly enhance its binding capacity. The dynamic analysis reveals increased flexibility in the RBD, particularly in loop regions crucial for hACE2 interaction. Mutations significantly alter the secondary structure, leading to greater flexibility and conformational adaptability compared to the wild type. Binding free energy calculations confirm that the Omicron RBD has a higher binding affinity (- 70.47 kcal/mol) to hACE2 than the wild-type RBD (- 61.38 kcal/mol). These results suggest that the altered interaction network and enhanced dynamics of the Omicron variant contribute to its increased infectivity, providing insights for the development of targeted therapeutics and vaccines.

SARS-CoV-2 Infection Among Children in Rondônia, Western Brazilian Amazon: SARS-CoV-2 Among Children in Rondônia

We analyzed 364 children symptomatic or asymptomatic for respiratory symptoms, aged 0.1 month-17 years, selected from primary healthcare units of different municipalities of Rondônia from June 2021 to September 2022. Data were collected from medical and electronic records for epidemiological characterization. The positive cohort (n = 96) was quantified using a real-time (RT) qPCR and sequenced by next-generation sequencing. Whole-genome sequences were obtained, SARS-CoV-2 strains were classified using the Pango system, and the maximum likelihood method was used for phylogenetic analyses. Among the patients, 59.34% (216/364) were male and 40.66% (148/364) were female. Children aged 10-14 years showed the highest rate of SARS-CoV-2 positivity. At the time of collection, 54.12% (197/364) of the patients were not age-eligible for immunization against COVID-19. The unvaccinated group accounted for 34.07% (124/364), with the highest proportion in the age groups of 5-9 and 10-14 years. Most patients exhibited mild symptoms. Seventy-nine high-quality genomes were obtained: Delta variant of concern (VOC) was the most prevalent (most abundant strain: AY.99.2), Omicron VOC was reported in 26 individuals (most frequent subvariant: BA.1.1), and Gamma VOC with 22 cases (12 cases of P.1 strain). The viral load showed a median of 7.26 log10 copies/mL, with a mean symptom duration of 4 days. Most of the cases were from children who were unvaccinated and age-ineligible for immunization and were associated with Delta and Omicron VOCs with an increase in subvariants during the study period.

Drug repurposing of argatroban, glimepiride and ranolazine shows anti-SARS-CoV-2 activity via diverse mechanisms

Despite the vast vaccination campaigns against SARS-CoV-2, vaccine-resistant variants have emerged, and COVID-19 is continuing to spread with the fear of emergence of new variants that are resistant to the currently available anti-viral drugs. Hence, there is an urgent need to discover potential host-directed - rather than virus-directed - therapies against COVID-19. SARS-CoV-2 enters host cells through binding of the viral spike (S)-protein to the host angiotensin-converting enzyme 2 (ACE2) receptor, rendering the viral port of entry an attractive therapeutic target. Accordingly, this study aimed to investigate FDA-approved drugs for their potential repurposing to inhibit the entry point of SARS-CoV-2. Accordingly, the FDA-approved drugs library was enrolled in docking simulations to identify drugs that bind to the Spike-ACE2 interface. The drugs list retrieved by the docking simulations was shortlisted to 19 drugs based on docking scores and safety profiles. These drugs were screened for their ability to prevent binding between ACE2 and S-protein using an ELISA-based Spike-ACE2 binding assay. Five drugs showed statistically significant inhibition of binding between ACE2 and S-protein, ranging from 4 % to 37 %. Of those five, argatroban, glimepiride and ranolazine showed potential antiviral activity at IC50 concentrations well below their CC50 assessed by the plaque assay. Their mode of antiviral action was then determined using the plaque assay with some modifications, which revealed that argatroban acted mainly through a direct virucidal mechanism, while glimepiride largely inhibited viral replication, and ranolazine exerted its antiviral impact primarily through inhibiting viral adsorption. In conclusion, this study has identified three FDA-approved drugs - argatroban, glimepiride and ranolazine - which could potentially be repurposed and used for the management of COVID-19.

Assessment of the Relationship between Pre-Existing Muscle Atrophy, Subcutaneous Fat Volume, and the Prognosis of COVID-19

Background: Coronavirus disease 2019 (COVID-19), with its rapid transmission and emergence, has become a major global public health concern. COVID-19 patients are at an increased risk of acute skeletal muscle loss and complications such as muscular weakness, depression, and anxiety. Furthermore, sarcopenia has been linked to COVID-19 vulnerability, hospitalization rates, and severity. This study aims to investigate the relationship between pre-existing sarcopenia, subcutaneous fat, and the prognosis of COVID-19. Methods: Patients over 18 with positive tests who had chest CT scans without underlying conditions were included in this cohort study. The ratio of muscle volume to the total body surface area was calculated. Patients were divided into four subgroups: outpatients, hospitalized, ICU admitted, and deceased. The initial muscle volume for each group was compared. Results: In total, 127 patients were included in the study, 63 (49%) of whom were male. The mean age of the patients was 51.8 ± 18.16 (from 23 to 87 years). In total, 27 patients (21.3%) were treated as outpatients, 49 patients (38.6%) were hospitalized, and 23 (18.1%) were admitted to the ICU. Twenty-eight patients (22%) died. The total muscle/surface area ratio was significantly associated with disease outcome and prognosis. The ratio was significantly lower in dead individuals (p = 0.017). Conclusions: Sarcopenia was discovered to be significantly associated with the severity of COVID-19 and a poor prognosis. Reducing the risk of severe COVID-19 is possible by identifying and managing sarcopenia-related risk factors.

Adapting the Flexible Farrington Algorithm for daily situational awareness and alert system to support public health decision-making during the SARS-CoV-2 epidemic in England

The Flexible Farrington Algorithm (FFA) is widely used to detect infectious disease outbreaks at national/regional levels on a weekly basis. The rapid spread of SARS-CoV-2 alongside the speed at which diagnostic and public health interventions were introduced made the FFA of limited use. We describe how the methodology was adapted to provide a daily alert system to support local health protection teams (HPTs) working in the 316 English lower-tier local authorities. To minimize the impact of a rapidly changing epidemiological situation, the FFA was altered to use 8 weeks of data. The adapted algorithm was based on reported positive counts using total tests as an offset. Performance was assessed using the root mean square error (RMSE) over a period. Graphical reports were sent to local teams enabling targeted public health action. From 1 July 2020, results were routinely reported. Adaptions accommodated the impact on reporting because of changes in diagnostic strategy (introduction of lateral flow devices). RMSE values were relatively small compared to observed counts, increased during periods of increased reporting, and were relatively higher in the northern and western areas of the country. The exceedance reports were well received. This presentation should be considered as a successful proof-of-concept.

Increased Resting and Peak Exercise Systolic Blood Pressure in Children Throughout the COVID-19 Pandemic

The COVID-19 pandemic created significant disruptions to daily life. Lockdown effects resulted in decreased exercise capacity and increased blood pressure in adults and adolescents in the first year of the pandemic. We examined changes in exercise capacity (peak workload, ventilatory anaerobic threshold-VAT, and VO2 peak), resting BP, and peak exercise BP in children before the COVID-19 pandemic and throughout five 6-month intervals of the pandemic. 951 maximal cardiopulmonary exercise tests completed by healthy children aged ≤ 18 years were analyzed retrospectively. BP was auscultated. Tests were divided into pre-pandemic and six-month intervals starting from the declaration of the pandemic (Interval 1: March 11 2020-August 2020, Interval 2: September 2020-February 2021, Interval 3: March-August 2021, Interval 4: September 2021-February 2022, Interval 5: March-August 2022). Peak workload, VAT, and VO2 peak were unchanged from pre-pandemic baseline until Interval 3, when they were significantly decreased. Exercise capacity then returned to values unchanged from baseline. Peak exercise systolic BP was significantly higher than baseline in Intervals 2, 4, and 5. Resting systolic BP was significantly higher than baseline in Interval 5. There was no significant difference in age, sex, BMI, or peak exercise heart rate between intervals. Peak exercise BP was elevated above pre-pandemic baseline when exercise capacity was unchanged. The decrease in exercise capacity subsequently resolved, but the increase in post-exercise BP remained in Intervals 4 and 5. An increase in peak exercise BP preceded a small but significant increase in resting systolic BP.