The emergence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) linked with coronavirus disease 2019 (COVID-19) poses a serious threat to public health worldwide. Firstly, the SARS-CoV-2 was reported in Wuhan, Hubei Province, China in December 2019. Initially, the major proportion of virus-infected cases (i.e. about 99%) was reported in China and now it is being reported in other counties as well. Humans begin to be infected within their communities and transmittance of the viral epidemic increased rapidly due to lack of understanding of its transmission routes and precautionary measures. The existence of SARS-CoV-2 in China threatened the population greatly due to the high incidence of fatal respiratory infections. Current investigations speculated that this virus transferred into a human from viral-infected bats. However, the process of interspecies viral transmission is an important scientific question to be addressed. Due to the continuous increase in the patients infected with COVID-19 associated pneumonia, the World Health Organization (WHO) has included this viral epidemic to the priority list of diseases. Therefore, accelerated research developments are required to control the spread of this outbreak, as it is declared as a public health emergency by WHO especially in the absence of efficacious drugs and vaccines. Our review encompasses the recent status of disease severity in China, a particular replication mechanism of SARS-CoV-2 and potential risks and precautionary measures required to avoid contact with this fatal viral infection.

Ethnopharmacological relevance: Novel coronavirus disease (COVID-19) outbroke in Wuhan has imposed a huge influence onto the society in term of the public heath and economy. However, so far, no effective drugs or vaccines have been developed. Whereas, the Traditional Chinese Medicine (TCM) has been considered as a promising supplementary treatment for the disease owing to its clinically proven performance on many diseases even like severe acute respiratory syndrome (SARS). Meanwhile, many side-effect (SE) reports suggest the SE of the TCM prescriptions cannot be ignored in curing the COVID-19, especially because COVID-19 always simultaneously leads to dramatic degradation of the patients’ physical condition. How to evaluate the TCM regarding to their latent SE is a urgent challenge. Aim of the study: In this study, we use an ontology-based side-effect prediction framework (OSPF) developed in our previous work and Artificial Neural Network (ANN)-based deep learning to evaluate the TCM prescriptions that are officially recommended in China for novel coronavirus (COVID-19). Materials and methods: Firstly, we adopted the OSPF developed in our previous work, where an ontology-based model separate all the ingredients in a TCM prescription into two categories: hot and cold. Then, we established a database by converting each TCM prescription into a vector containing the ingredient dosage and the according hot/cold attribution as well as the safe/unsafe label. And, we trained the ANN model using this database, after which a safety indicator (SI), as the complementary percentage of side-effect (SE) possibility, is then given for each TCM prescription. According to the proposed SI from high to low, we re-organize the recommended prescription list. Secondly, by using this method, we also evaluate the safety indicators of some other famous TCM prescriptions that are not in the recommended list but are used traditionally to cure flu-like diseases for extending the potential treatments. Results: Based on the SI generated in the ANN model, FTS, PMSP, and SF are the safest ones in recommended list, which all own a more-than-0.8 SI. Whereas, JHQG, LHQW, SFJD, XBJ, and SHL are the prescriptions that are most likely unsafe, where the indicators are all below 0.2. In the extra list, the indicators of XC, XQRS, CC, and CHBX are all above 0.8, and at the meantime, XZXS, SJ, QW, and KBD’s indicators are all below 0.2. Conclusions: In total, there are seven TCM prescriptions which own the indicators more than 0.8, suggesting these prescriptions should be considered firstly in curing COVID-19, if suitable. We believe this work will provide a reasonable suggestion for the society to choose proper TCM as the supplementary treatment for COVID-19. Besides, this work also introduces a pilot and enlightening method for creating a more reasonable recommendation list of TCM to other diseases.

Background: COVID-19 vaccines have been linked to myocarditis which in some circumstances can be fatal. This systematic review aims to investigate potential causal links between COVID-19 vaccines and death from myocarditis using post-mortem analysis. Methods: We performed a systematic review of all published autopsy reports involving COVID-19 vaccination-related myocarditis through July 3^rd, 2023. All autopsy studies that include COVID-19 vaccine-induced myocarditis as a possible cause of death were included, without imposing any additional restrictions. Causality in each case was determined by three independent reviewers with cardiac pathology experience and expertise. Results: We initially identified 1,691 studies and, after screening for our inclusion criteria, included 14 papers that contained 28 autopsy cases. The cardiovascular system was the only organ system affected in 26 cases. In 2 cases, myocarditis was characterized as a consequence from multisystem inflammatory syndrome (MIS). The mean and median number of days from last COVID-19 vaccination until death was 6.2 and 3 days, respectively. Most of the deaths occurred within a week from the last injection. We established that all 28 deaths were causally linked to COVID-19 vaccination by independent adjudication. Conclusions: The temporal relationship, internal and external consistency seen among cases in this review with known COVID-19 vaccine-induced myocarditis, its pathobiological mechanisms and related excess death, complemented with autopsy confirmation, independent adjudication, and application of the Bradford Hill criteria to the overall epidemiology of vaccine myocarditis, suggests there is a high likelihood of a causal link between COVID-19 vaccines and death from suspected myocarditis in cases where sudden, unexpected death has occurred in a vaccinated person. Urgent investigation is required for the purpose of risk stratification and mitigation in order to reduce the population occurrence of fatal COVID-19 vaccine-induced myocarditis.

Aging induces numerous physiological alterations, with immunosenescence emerging as a pivotal factor. This phenomenon has attracted both researchers and clinicians, prompting pro-found questions about its implications for health and disease. Among the contributing factors, one intriguing actor in this complex interplay is human cytomegalovirus (CMV), a member of the herpesvirus family. Latent CMV infection exerts a profound influence on the aging immune system, potentially contributing to age-related diseases. This review delves into the intricate relationship between immunosenescence and CMV, revealing how chronic viral infection im-pacts the aging immune landscape. We explore the mechanisms through which CMV can im-pact both the composition and functionality of immune cell populations and induce shifts in in-flammatory profiles with aging. Moreover, we examine potential role of CMV in such pathol-ogies as cardiovascular diseases, cancer, neurodegenerative disorders, COVID-19, and Long COVID. This review underlines the importance of understanding the complex interplay be-tween immunosenescence and CMV. It offers insights into the pathophysiology of aging and age-associated diseases, as well as COVID-19 outcomes among the elderly. By unraveling the connections between immunosenescence and CMV, we gain a deeper understanding of aging's remarkable journey and the profound role that viral infections play in transforming the human immune system.

Background: Infections of Coronavirus Disease-2019 (COVID-19) can cause long-term effects known as long COVID. This pilot study aimed to evaluate the feasibility of a clinical study as well as the efficacy and safety of traditional East Asian herbal medicines in alleviating fatigue and cognitive dysfunction “brain fog” in patients with long COVID. Methods: This prospective pilot study investigated the use of three types of herbal medicines, Bojungikki-tang (BIT), Kyungok-go (KOG), and Cheonwangbosim-dan (CBD), for a 12-week period as potential treatments for fatigue and cognitive dysfunction in patients with long COVID. Forty-five patients with long COVID were recruited, and one of three drugs was given based on the patient’s symptoms and pattern identification. The effect of herbal medications on fatigue and cognitive function outcomes was assessed over a 36-week period, with patient adherence closely monitored. Results: After 12 weeks of herbal drug administration, fatigue symptoms improved significantly across all groups, with treatment success rates of 80%, 53.33%, and 46.67% in the BIT, KOG, and CBD groups, respectively. However, “brain fog” symptoms showed less improvement, with treatment success rates of 40%, 46.67%, and 13.33% in the BIT, KOG, and CBD groups, respectively. All adverse events reported were mild and unrelated to the medication. The study design was found to be feasible with high medication adherence. Conclusions: This study demonstrated the feasibility of conducting a clinical trial with three herbal medicines to treat long COVID symptoms like fatigue and “brain fog.”

Coronavirus disease 2019 (COVID-19), can manifest with ocular symptoms. These symptoms can be divided into isolated events attributed to COVID-19 and those occurring in multisystem inflammatory syndrome in children (MIS-C), a newly diagnosed disease entity associated with COVID-19 infection. Currently, the literature lacks specific guidelines and treatment regimens for COVID-19 ocular symptoms, especially in children.

Like all RNA viruses, SARS-CoV-2 shows high mutation rate, which has led to the emergence of new variants. Among them, Gamma and Delta developed at the turn of 2020-2021 in Amazonas and India, two ecoregions characterized by hot-humid weather, very similar to that of the summer season due to climate change in Italy, the first Western country to have been hit hard by COVID-19 and to experience lockdown restrictions in a democratic framework of 58,85 million people. Methods: during the state of national health emergency and the Draghi government, the Civil Defense Department daily released the aggregate data coming from the Ministry of Health, the Higher Institute of Health, the Independent Provinces and the Italian Regions, in order to inform about the pandemic situation in Italy. Among these data there were the number of deaths, hospitalizations in intensive care units (ICU), non-ICU patients, contagions, and performed swabs. By means of a team effort, we have collected and elaborated all these data, comparing COVID-19 pandemic in Italy during the summers 2020 (following the nationwide lockdown), 2021 and 2022. Results: from summer 2020 (before mass vaccination) to summers 2021 (after primary mass vaccination) and 2022 (after booster mass vaccination) all pandemic trend indicators have showed a sharp worsening in Italy. COVID-19 deaths increased by ≈298% and ≈834%, ICU hospitalizations by ≈386% and ≈310%, non-ICU hospitalizations by ≈224% and ≈600%, contagions by ≈627% and ≈6.850% (i.e. ≈68,50 times), swabs by ≈354% and ≈370%, and the mean positivity rate passed from ≈1% to ≈2% and ≈20%, respectively. Conclusions: SARS-CoV-2 can be transmitted in any climate, including areas with hot and humid weather, and the emergence of variants adapted to hot-humid climate may result in summer COVID-19 outbreaks, even in neither tropical nor subtropical countries. Although COVID-19 vaccines can confer cross-protection against newly emerging variants, this cross-immunity is obviously not absolute but limited, also taking into account that vaccine protection wanes considerably after 6 months. It follows that a subject vaccinated at the beginning of winter will not be completely covered in the height of summer, without forgetting the unvaccinated. As a final remark, the long nationwide lockdown made it possible to flatten SARS-CoV-2 circulation and, therefore, its negative impact on Italy during summer 2020.

Abstract: (1) Background: Post-COVID syndrome is defined as symptoms that occur simultane-ously with or after COVID-19 infection, last for 12 weeks, and are not due to another diagnosis. Limited data are available on people’s long-term quality of life (QoL) following COVID-19 infection. The aim of this cross-sectional study was to investigate long-term QoL after COVID-19 among employees of the St. Josef Hospital in Paderborn, Germany, and to identify risk factors. (2) Methods: A monocentric, cross-sectional study was conducted using the validated and digitized WHOQOL-BREF questionnaire via Netigate® between 10/2022 and 02/2023. Data on QoL and global health status were collected in the following four domains: physical health, mental health, social relationships, and environment. (3) Results: The response rate was 73.84% (923/1250). Furthermore, 63.45% of hospital staff respondents reported at least one persistent symptom after COVID-19 infection, leading to significant differences in QoL. Pre-existing conditions, persistent symptoms, and disability after COVID-19 infection, as well as high BMI, no partnership, and low educational level were found to significantly contribute to long-term low QoL. (4) Conclusions: Obesity, lack of partnership, and a low level of education were independent risk factors for lower QoL post-COVID-19 infection in this cohort of hospital staff. Further multicenter studies are re-quired to validate the incidence and their suitability as independent risk factors for post-COVID syndrome.

Coronavirus disease 2019 (COVID-19), an infectious disease pandemic, affected millions of people globally, resulting in high morbidity and mortality. Causing further concern, significant proportions of COVID-19 survivors suffer from the lingering health effects of severe acute respiratory syndrome virus 2 (SARS-CoV-2), the pathogen that causes COVID-19. One of the diseases manifesting as a post-acute sequela of COVID-19 is new-onset diabetes. This systematic review and meta-analysis will perform a comprehensive and systematic literature search to estimate the burden of new-onset diabetes after COVID-19. Specifically, this study will estimate the magnitude of the incidence, risk, and population-attributable fraction of new-onset diabetes. The study will also explore and summarize the data on the natural history or clinical course of the new-onset diabetes cases. Five bibliographic databases, including PubMed, MEDLINE, Embase, Scopus, and Web of Science, will be searched for eligible studies. The World Health Organization COVID-19 Research Database, preprint servers, and conference abstracts will also be searched. Cohort studies of COVID-19 patients of all ages providing data on new cases of diabetes in the post-acute phase of the illness will be included. The comparators to estimate the pooled risk ratio will be those with no diagnosis of COVID-19 or those infected with other respiratory tract infections. The findings of this study will likely inform clinical practice, public health guidelines, and policies for early detection and treatment of new-onset diabetes cases in the long-COVID phase. This protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO: No.CRD42020200432).

The COVID-19 Omicron variant, reported to be the most immune evasive variant of COVID-19, is resulting in a surge of COVID-19 cases globally. This has caused schools, colleges, and universities in different parts of the world to transition to online learning. As a result, social media platforms such as Twitter are seeing an increase in conversations related to online learning. Mining such conversations, such as Tweets, to develop a dataset can serve as a data resource for interdisciplinary research related to the analysis of interest, views, opinions, perspectives, attitudes, and feedback towards online learning during the current surge of COVID-19 cases caused by the Omicron variant. Therefore this work presents a large-scale public Twitter dataset of conversations about online learning since the first detected case of the COVID-19 Omicron variant in November 2021. The dataset is compliant with the privacy policy, developer agreement, and guidelines for content redistribution of Twitter, as well as with the FAIR principles (Findability, Accessibility, Interoperability, and Reusability) principles for scientific data management. The paper also briefly outlines some potential applications in the fields of Big Data, Data Mining, Natural Language Processing, and their related disciplines, with a specific focus on online learning during this Omicron wave that may be studied, explored, and investigated by using this dataset.

Knowing the number of cases of an epidemic is the first function of epidemiological surveillance. An important underreporting of cases was observed in many places during the first wave of COVID-19 pandemic. To estimate this underreporting in the COVID-19 outbreak of Borriana (Valencia Community, Spain), during “Falles” mass gathering events in March 2020, a cross-sectional study was performed in June 2020 querying public health register. Logistic regression models were used. From a total of 468 symptomatic COVID-19 cases diagnosed in the outbreak by anti-SARS-CoV-2 serology, 36 cases were reported (7.7%), thus an underreporting of 92.3% (95% Confidence Interval [CI] 89.5%-94.6%), 13 unreported cases for every reported case. Only positive SARS-CoV-2 polymerase chain reaction cases were predominantly reported due to a limited testing capacity and following a national protocol. Significant factors associated with underreporting were no medical assistance for COVID-19 disease, adjusted odds ratio [aOR] 10.83 (95% CI 2.49-47.11), no chronic illness, aOR=2.81 (95% CI 1.28-6.17), middle and lower social classes, aOR=3.12 (95% CI 1.42-6.85), younger age, aOR=0.97 (95% CI 0.94-0.99), shorter duration of illness, aOR=0.98 (95% CI 0.97-0.99). To improve surveillance, studies of representative population samples are necessary to estimate the magnitude of future epidemics, and novel approaches are recommended.

Introduction: This population-based retrospective cohort study assesses rates of adverse events (AEs) involving cerebral thromboembolism (CTE) after COVID-19 vaccines. Methods: Data were collected from the U.S. Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) Vaccine Adverse Event Reporting System (VAERS) database from January 1, 1990 to December 31, 2023. CTE AEs after COVID-19 vaccines were compared to those after influenza vaccines and after all other vaccines using proportional reporting ratio (PRR) analysis by time. Results: There are 5137 cerebral thromboembolism AEs reported in the 3 years (36 months) after COVID-19 vaccines compared to 52 AEs for the influenza vaccines over the past 34 years (408 months) and 282 AEs for all other vaccines (excluding COVID-19) over the past 34 years (408 months). The PRR’s are significant when comparing AEs by time from COVID-19 vaccines to that of the influenza vaccines (p < 0.0001) or to that of all other vaccines (p < 0.0001). The CTE AEs PRR by time (95% confidence intervals) for the COVID-19 vaccine AEs vs influenza AEs is 1120 (95% confidence interval (723-1730), p < 0.0001) and for COVID-19 vaccines vs all others is 207 (95% confidence interval (144-296), p < 0.0001). Cerebral venous thromboembolism AEs are female predominant with a female/male odds ratio of 1.63 (95% confidence interval (1.52-1.74), p < 0.0001). Conversely, cerebral arterial thromboembolism has a nonsignificant male preponderance. Cerebral venous thromboembolism is far more common than cerebral arterial thromboembolism over 36 months with an odds ratio (OR) of 14.8 (95% confidence interval 14.0-15.5, p < 0.0001). Atrial fibrillation, the most common identifiable cause of cerebral arterial thromboembolism, occurs far more commonly after the COVID-19 as compared to all other vaccines with a PRR of 123 (95% CI 88.3-172, p < 0.0001) Conclusions: There is an alarming breach in the safety signal threshold concerning cerebral thrombosis AEs after COVID-19 vaccines compared to that of the influenza vaccines and even when compared to that of all other vaccines. An immediate global moratorium on the use of COVID-19 vaccines is necessary with an absolute contraindication in women of reproductive age.

SARS-CoV-2 is an obligatory intracellular pathogen that requires of a lipid bilayer membrane for its transport, to build its nucleocapsid envelope and to fuse with the host cell. The biological membranes are constituted by phospholipids (PLs) and vitamin E (Vit E) protects them from oxidative stress (OS). The aim of this study was to demonstrate if the treatment with Vit E restores the modified profile of the FA in PLs in serum from patients with coronavirus disease-19 (COVID-19). We evaluated Vit E, total fatty acids (TFA), fatty acid of the phospholipids (FAPL), total phospholipids (TPLs), 8-isoprostane, thromboxane B2 (TXB2), prostaglandins (PGE2 and 6-keto-PGF1α), interleukin-6 (IL-6) and C-reactive protein (CRP) in serum from 22 COVID-19 patients before and after treatment with Vit E and compared the values with those from 23 healthy subjects (HS). COVID-19 patients showed a decrease in Vit E, TPLs, FAPL and TFA in serum in comparison to HS (p≤0.01) and Vit E treatment restored their levels (p≤0.04). Likewise, there was an increase IL-6 and CRP in COVID-19 patients in comparison with HS (p≤0.001) and the treatment with Vit E decreased their levels (p≤0.001). Treatment with Vit E contributes to restore the modified profile of the PLs in the SARS-CoV-2 infection and this leads to a decrease of OS and of the inflammatory process.

This research uses a gravity model method to investigate the factors determining the number of tourists visiting Australia. Understanding the variables that draw visitors to specific locations is essential for policymakers and other stakeholders in the tourism sector since tourism continues to play a significant role in the economy of many countries worldwide. Despite the widespread use of gravity models in the analysis of international tourism flows, only a tiny amount of attention has been paid to particularly researching the flow of tourists to Australia. This research addresses this knowledge gap by analyzing the variables influencing travel patterns to Australia. The gravity model framework is used, and it considers factors like gross domestic product, gross domestic product per capita, migratory stocks, distance, population size, cost of living, and cultural similarities. The purpose of this research is to aid in developing focused marketing strategies by providing insights into the factors that influence the flow of tourists to Australia via the analysis of these variables. The results are anticipated to add to the current literature on gravity modeling in tourist research and give practical implications for industry stakeholders and policymakers. The discussion of the findings, their ramifications, and possible directions for further study serves as the conclusion of the work.

Introduction: The emergency of the SARS-CoV-2 virus spread and its subsequent global pan-demic have raised significant concerns regarding its impact on pregnancy outcomes. This review aims to summarize the emerging data on the risk of preterm delivery in pregnant women infected with SARS-CoV-2. Materials and Methods: A systematic search was conducted from March 2020 to December 2023 using PubMed, following PRISMA guidelines. Studies correlating maternal COVID-19 infection with preterm birth were included. Results: Thirteen studies were analyzed, indicating a higher incidence of preterm birth in SARS-CoV-2 positive pregnant women compared to controls. The average incidence rate of pre-term birth in infected patients was 18.5%, with a median of 12.75%, while non infected women showed an average incidence of preterm birth of 10% with a median of 8.2%. Discussion: Studies suggest an association between SARS-CoV-2 infection during pregnancy and increased risk of preterm birth and cesarean section. Severity of symptoms and underlying comorbidities further elevate this risk. Notably, infections during the third trimester pose the highest risk of preterm birth. Conclusion: Preventing SARS-CoV-2 infection during pregnancy is crucial to mitigate adverse obstetric outcomes. Close monitoring and tailored interventions for infected pregnant women, particularly those in later trimesters and with comorbidities, are imperative to reduce the risk of preterm birth and improve maternal-fetal outcomes.

Purpose: The pandemic, named COVID-19, which shook global economy, production and trade has equally affected the social and domestic lives of ours. In this study the COVID-19’s impact has been investigated on lack of social interaction, financial stress and how it influences the domestic violence in a developing country like Pakistan. The study focuses on some of the important factors that are root causes of increased domestic violence in Pakistan. Design/methodology/approach: The study is quantitative and survey questionnaire has been conducted for structural equation modelling (SEM) to evaluate the hypotheses. The modified scale was validated using confirmatory factor analysis, the Purposive and snowball sampling technique is used for collecting data from 200 respondents of Punjab Pakistan for data analysis through SPSS and SmartPLS. Findings: It is revealed that Covid 19 has a significant effect on lack of social interaction and financial stress. Moreover, lack of social interaction and financial stress also enhances domestic violence. Finally, lack of social interaction and financial stress mediates COVID-19 and domestic violence. Originality/value: This study appears to be frontier research which determines the impact of COVID-19 on lack of social interaction, financial stress and domestic violence particularly in a developing country like Pakistan.

In this research, we present the first steps taken towards a data-driven agent-based model (ABM) specifically designed for simulating infectious disease dynamics in Greece. Amidst the ongoing COVID-19 pandemic caused by SARS-CoV-2, this research holds significant importance as it can offer valuable insights into disease transmission patterns and assist in devising effective intervention strategies. To the best of our knowledge, no similar study has been conducted in Greece. We constructed a prototype ABM that utilizes publicly accessible data to accurately represent the complex interactions and dynamics of disease spread in the Greek population. By incorporating demographic information and behavioral patterns, our model captures the specific characteristics of Greece, enabling accurate and context-specific simulations. By using our proposed ABM, we aim to assist policymakers in making informed decisions regarding disease control and prevention. Through the use of simulations, policymakers have the opportunity to explore different scenarios and predict the possible results of various intervention measures. These may include strategies like testing approaches, contact tracing, vaccination campaigns, and social distancing measures. Through these simulations, policymakers can assess the effectiveness and feasibility of these interventions, leading to the development of well-informed strategies aimed at reducing the impact of infectious diseases on the Greek population. This study is an initial exploration toward understanding disease transmission patterns and a first step towards formulating effective intervention strategies for Greece.

In 2019, due to the global pandemic of the new coronavirus (SARS-CoV-2), lockdown was imposed in Greece. Children with Type 1 Diabetes (T1D) during that period had to maintain a good level of glycemic control despite the subversive changes in their lives. The aim of this study was to assess the impact of lockdown on glycemic control and lifestyle changes of children with type 1 diabetes. The present cross-sectional study included 59 children with T1D who measured their glucose levels through glucose monitoring systems (Continuous Glucose Monitoring, CGM) and Flash Glucose Monitoring (FGM)). Their glycemic profile and demographic data were recorded in three different periods (before, during and after the lockdown). The changes in their daily routine were farther investigated through a short questionnaire which assesses changes in lifestyle-related behavior during COVID 19 pandemic. A significant improvement was noted in the glycemic control of children with T1D during the restrictive measures. Boys scored higher on scale of lifestyle behavior changes during the pandemic (-0.1 vs. -0.3, p=0.015). The results of this study highlight the need for continuous education and insistence on children's adherence with the treatment plan and the beneficial effects of using the new technology for easier monitoring.

Several criteria exist to diagnose pulmonary aspergillosis with varying degrees of certainty in specific populations, including oncohaematological patients (EORTC/MSG), ICU patients (AspICU) and Covid-19 patients (ECMM). At the beginning of the pandemic, however, the diagnosis of Covid-19 Associated Pulmonary Aspergillosis (CAPA) could not be performed easily, and the decision to treat (DTT) was empirical. In this cross-sectional retrospective study including patients with SARS-CoV-2 infection and a suspicion of CAPA, we studied the concordance between the DTT and the three diagnostic criteria using Cohen’s coefficient, then we identified the factors associated with the DTT and we corrected by treatment to study the influence of the diagnostic criteria on survival. We showed good concordance of DTT and AspICU and ECMM criteria, with “compatible signs”, “positive culture” and “positive galattomannan” influencing the DTT. Treatment also showed a positive effect on survival once corrected for a putative, possible or probable diagnosis of CAPA using AspICU and ECMM criteria. We conclude that EORTC/MSGERC are not considered applicable in clinical practice due to lack of inclusion of signs and symptoms and do not lead to improved survival. AspICU and ECMM criteria showed a good degree of agreement with the DTT and a positive correlation with patient recovery.

(1) Background: Until December 2021, French Guiana (FG), located in South America, faced four consecutive COVID-19 epidemic waves. This study sought to analyze the mortality trend of severe COVID-19 patients admitted to the referral ICU of FG. (2) Methods: We conducted a prospective, observational, and non-interventional study in ICU at Cayenne Hospital. We included 383 patients older than 18 admitted with SARS-CoV-2-related pneumonia hospitalized from May 2020 to December 2021. The study covers three periods. Period 1 (Waves 1 and 2, original variant), period 2 (Wave 3, gamma variant), and period 3 (Wave 4, delta variant). (3) Results: The median age was 63 years (52-70). Frailty was diagnosed in 36 patients over 70 (32.4%). Only 4.8% of patients were vaccinated. The median ICU LOS was 10 days (6-19). Hospital mortality was 37.3%. It was 30.9% in period 1, 36.6% in period 2 (p=0.329 vs. period 1), and 47.1% in period 3 (0.015 vs. period 1). In multivariate analysis, independent factors associated with hospital mortality were age more than 40 years (]40-60 years] OR=5.2, 95%CI: 1.4-19.5; (]60-70 years] OR=8.5 95%CI: 2.2-32; (]70+ years] OR=17.9, 95%CI: 4.5-70.9), frailty (OR=5.6, 95%CI: 2.2-17.2), immunosuppression (OR=2.6, 95%CI: 1.05-6.7), and MV use (OR=11, 95%CI: 6.1-19.9). This model had an overall sensitivity of 72%, a specificity of 80.4%, a positive predictive value of 68.7%, and a negative predictive value of 82.8%. (4) Conclusions: The mortality of severe COVID-19 patients in French Amazonia was higher during the delta variant wave. This over-death is explained by the virulence of the responsible SARS-CoV-2 variant and the under-vaccination coverage of the studied population.

This study investigates the impact of the economic downturn induced by the COVID-19 pandemic on nutritional health disparities among women. The research aimed to understand how economic challenges have influenced dietary choices, access to nutritious food, and overall nutritional well-being in different socioeconomic groups of women.Utilizing a mixed-methods approach, the study combined quantitative data from national health and economic databases with qualitative insights from interviews conducted with a diverse group of women. The quantitative analysis focused on trends in nutritional health indicators and economic variables pre- and post-pandemic. Simultaneously, the qualitative component explored personal experiences and perceptions related to nutrition and economic hardships during the pandemic.The findings revealed a significant correlation between the economic downturn and worsening nutritional health among women, especially in low-income and marginalized communities. Women in these groups reported reduced access to healthy food options, increased reliance on less nutritious food due to budget constraints, and a general decline in dietary quality. This decline was less pronounced in higher-income groups, highlighting a clear disparity.Moreover, the study observed that the pandemic exacerbated pre-existing nutritional inequalities, with vulnerable groups experiencing a more pronounced impact. The research also noted that community support systems and public health interventions played a crucial role in mitigating some of these effects.In conclusion, the COVID-19 pandemic has not only posed a direct health challenge but has also indirectly affected women's nutritional health through economic strain. The study underscores the need for targeted nutritional support and economic policies that prioritize the health of women, particularly those from socioeconomically disadvantaged backgrounds.

Enterprise risk management (ERM) was introduced in the 1990s and has become an expectation by boards of directors and regulators as a sign of good management and good corporate governance. However, many organizations struggle to implement ERM, and still seek practical ad-vice on ERM implementation. This article explains many of the reasons why organizations are unsuccessful in their efforts at implementation and provides practical solutions by an experienced risk manager and consultant, an ex-Chief Risk Officer, and an academic, all who has writ-ten extensively in the subject. This article should be of interest to practitioners involved in implementing ERM, to consultants in ERM, and to academics teaching courses on ERM, risk management, and related topics. This article also provides a base against which further future re-search can be done as ERM best practices continue to evolve.

The emergence of the COVID-19 pandemic triggered a swift transition to online learning, remote work and an increased demand for proficiency in telehealth and digital health among health professions students as they prepare for their future careers. In responding to the question: “What are the essential constructs and the validity of a digital competence assessment scale for health professions students", this study sought to develop and validate a digital competence assessment scale (DigiCAS-HPS). The present study followed a mixed-methods approach: qualitative methods (phase 1) for generating and refining items in the scale through literature review on digital frameworks, pilot testing and expert review, and quantitative methods (phase 2) including exploratory and confirmatory factor analysis for its validation. The study revealed a two-factor structure, encompassing Digital Communication, Collaboration, and Online Security (Factor 1) and Digital Content Development and Software Mastery (Factor 2), demonstrating strong construct validity and reliability. Regarding differences in digital competence across groups, older and soon-to-graduate students exhibited higher proficiency in digital content development and software mastery. The two critical facets of DigiCAS-HPS scale could tailor training programs and ensure that health professions students are well-prepared for the evolving telehealthcare landscape. This promotes the growth and accessibility of telehealth, which is increasingly vital in the post-COVID-19 new normal era.

During the pandemic, nurses experienced anger that stemmed from a sense of threat, frustration or even a sense of injustice. The purpose of this study was to examine the relationship between vaccination hesitancy, anger, cynicism and medical mistrust among nurses, as there are no relevant studies in the literature. The study was conducted online by completing self-report questionnaires. The Dimensions of Anger Reactions-5, the 8-item "Cynical Distrust" scale and the Medical Mistrust Multiformat Scale were used. For vaccination hesitancy, two questions with a 5-point scale were used; one question examining hesitancy to get vaccinated with the COVID-19 vaccine, and another question examining hesitancy to get vaccinated with the influenza vaccine. 387 nurses (66 men and 321 women) participated in the study. Nurses showed statistically greater hesitancy for the COVID-19 vaccine compared to hesitancy for the influenza vaccine. The variation in Vaccine Hesitancy was explained by the scores in the Medical Mistrust Multiformat Scale, the Dimensions of Anger Reactions and the Cynical Distrust Scale. The Medical Mistrust Multiformat Scale mediated the relationship between Cynical Distrust Scale and Total Vaccine Hesitancy. The Dimensions of Anger Reactions Scale significantly moderated the indirect effect of Cynical Distrust Scale on Total Vaccine Hesitancy through the Medical Mistrust Multiformat Scale. In conclusion, it is highly likely that anger is involved in reported vaccine hesitancy both by activating schemas of distrust in others and by adopting antisystemic views of mistrust in the medical system.

The best form of prevention against human infection through bacteria, viruses and other parasites is ozone disinfection of wastewater and drinking water as a highly effective, well-known method. As a therapeutic measure, various preclinical studies showed promising results, which are being revisited and reconsidered in times of pandemics and led to interesting results in recent clinical trials and reports, as presented by the example of protective measures against covid-19 in particularly vulnerable clinical personnel. In patients with rheumatoid arthritis, repeated ozone treatments have led to new findings in the "immunomodulation" through ozone. The more effective immune response is discussed as the response of innate immune memory and opens interesting aspects for complementary treatment of autoimmune diseases.

Coronavirus disease (COVID-19) and its outcomes remain one of the most challenging problems today. COVID-19 in children could be asymptomatic but can result in a fatal outcome, therefore, prediction of the disease severity is important. The goal was to investigate the human genetic factors that could be associated with COVID-19 severity in children. Single nucleotide polymor-phisms of the following genes were studied: ACE2 (rs2074192), IFNAR2 (rs2236757), TYK2 (rs2304256), OAS1 (rs10774671), OAS3 (rs10735079), CD40 (rs4813003), FCGR2A (rs1801274) and CASP3 (rs113420705). In the case-control study were 30 children with mild or moderate course of the disease; 30 with severe COVID-19 symptoms and multisystem inflammatory syndrome in children (MIS -C) and 15 healthy who did not have COVID-19 infection (PCR negative, Ig G negative). The study revealed that ACE2 rs2074192 (allele T), IFNAR2 rs2236757 (allele A), OAS1 rs10774671 (allele A), CD40 rs4813003 (allele C), CASP3 rs113420705 (allele C) and male sex contribute to severe course COVID-19 infection, and MIS-C in 85.6% of cases. The World Health Organization reported new COVID-19 variants may cause previously unseen symptoms in chil-dren. Although the study has limitation due to cohort size, the findings can help provide a better understanding of SARS-CoV-2 infection and proactive pediatric patient management.

Molnupiravir, a prodrug known for its broad antiviral activity, demonstrated efficacy in animal models of Covid-19, prompting clinical trials where initial results indicated a significant effect against the disease. However, subsequent clinical studies did not confirm these findings, leading to the rejection of molnupiravir for permanent market authorization in many countries. This report critically assessed 19 studies published in 17 reports that investigated the efficacy of molnupiravir in animal models of Covid-19 with the purpose of determining how well the design of these models informed human studies. We found that the administered doses of molnupiravir in most studies involving animal Covid-19 models were disproportionately higher than the dose rec-ommended for human use. Specifically, when adjusted for body surface area, half of the doses of molnupiravir used in the animal studies were more than twice as high as the human dose. Addi-tionally, the drug was frequently given prophylactically or shortly after SARS-CoV-2 inoculation in these models, in contrast to clinical trials where such timing is not consistently achieved. Furthermore, the recommended five-day treatment duration for humans was exceeded in several animal studies. Collectively, we suggest that these design elements in the reported animal studies contributed to a bias favoring molnupiravir, and thus inflated expectations for its efficacy against Covid-19. Addressing these elements may offer avenues to enhance the clinical efficacy of mol-nupiravir for treatment of Covid-19 that include dose increment, early treatment, and admin-istration by inhalation along with use of molnupiravir in antiviral combination therapy.

This study updates previous research showing that 22 all-cause mortality in 31 European countries increased over time the higher the 21 COVID-19 full vaccination uptake. The update illuminates that a one percentage point increase in 21 full vaccination uptake initially decreased all-cause mortality from Jan to Mar 22 by –0.423 percent (95% CI –0.577, –0.270), but the following 14 months, a one percentage point increase in 21 booster vaccination uptake oppositely increased mortality by 0.366 percent (95% CI 0.250, 0.482). The findings indicate that full vaccination initially prevented mortality, but subsequently, booster vaccination, in particular, detrimentally and consistently induced higher mortality. The effects remained robust when controlling for alternative explanations. Studies have argued that heat waves caused mortality in the 22 summer and energy prices caused mortality in the 22-23 winter. However, the update shows that booster vaccination consistently induced higher mortality when neither heat waves nor energy prices were likely explanations.

Amidst the transformative backdrop of the post-Covid-19 context, the researcher embarks on a qualitative exploratory study to investigate the intricate interplay of religiosity, educational engagement, and campus life among college students at St. Michael's College, Iligan City. Guided by a theoretical framework integrating Vygotsky's sociocultural theory, Fredricks et al.'s engagement theory, and Pascarella & Terenzini's educational impact theory, this study delves into the dynamic fruition of religiosity in response to the pandemic's impact. Employing purposeful and maximum variation sampling, the investigation unravels narratives from interviews, focus group discussions, and observations. Through thematic analysis, themes of "Adaptive Integration," "Religious Resilience," "Community Nexus," "Challenges of Synchronization," and "Identity Negotiation" emerge. In the discourse of these themes, strategies students employ to navigate challenges arising from this confluence are unearthed. Rooted in a deep understanding of the context, this study presents implications for fostering holistic growth within an inclusive educational environment. As the findings and insights are presented, stakeholders are invited to reimagine the role of religiosity, educational engagement, and campus life in shaping the holistic student experience in a world forever changed.

Kidney transplant recipients (KTR) show higher morbidity and mortality from COVID-19 than the general population and have an impaired response to vaccination. We analyzed COVID-19 incidence and clinical outcomes in a single-center cohort of approximately 2500 KTR. Between February 1, 2020 and July 1, 2022, 578 KTR were infected with SARS-CoV-2, with 25 (4%) recurrent infections. 208 KTR (36%) were hospitalized, and 39 (7%) died. Among vaccinated patients, infection with the Omicron variant had a mortality of 2%. Unvaccinated patients infected with the Omicron variant showed mortality (9% vs. 11%) and morbidity (hospitalization 52% vs. 54%, ICU-admission 12% vs. 18%) comparable to the pre-Omicron era. Multivariable analysis revealed, being unvaccinated (OR = 2.15, 95% CI [1.38, 3.35]), infection in the pre-Omicron era (OR = 3.06, 95% CI [1.92, 4.87]), and higher patient age (OR = 1.04, 95% CI [1.03, 1.06]) are independent risk factors for COVID-19 hospitalization, whereas steroid-free immunosuppressive regimen was found to reduce the risk of COVID-19 hospitalization (OR = 0.51, 95% CI [0.33, 0.79]). This suggests that both, virological changes in the Omicron variant and vaccination, reduce the risk for morbidity and mortality from COVID-19 in KTR. Our data extend the knowledge from the general population to KTR and provide important insights into outcome during the Omicron era.

The current study is to examine the disparities in physical activity (PA), sedentary behavior (SB), and stress levels in Korean adolescents concerning changes in their perception of family socio-economic status (SES) during COVID-19. Among a total of 6144 Korean adolescents aged 12 to 18, the participants were categorized into two groups based on their responses regarding changes in their family SES during COVID-19: Lower SES (n = 3072) and Non-changed SES (n = 3072), with matching in terms of age, gender, and BMI. All variables were assessed using the 16th year (2020) of the Korean Youth Risk Behavior Survey. Statistical analyses were conducted using SPSS 26.0 version, employing independent t-tests to examine anthropometrics’ differences and multinominal logistic regression to predict the impact of perception of family SES on PA, SB, and stress while comparing the two groups. The significance level was set at α = 0.05. Adolescents in the Lower SES group were less likely to engage in vigorous-intensity PA (VPA) and muscular strength activities compared to those in the Non-changed SES group (p < 0.001) and were 2.3 times more likely to experience a very-severe stress level than the Non-changed SES group (p < 0.001). These results shed light on the importance of promoting VPA and muscular strength activities in adolescents for their physical and mental well-being, particularly during potential future pandemics. Understanding the impact of perceived SES changes on health behaviors can inform targeted interventions and support strategies to improve the health outcomes of adolescents during challenging times.

(1) Background: To fight for COVID-19 pandemic, immunity against SARS-CoV-2 should be achieved not only through natural infection but also vaccination. Controversies exist about the effect of COVID-19 vaccination on previously infected persons; (2) Methods: A prospective cohort was undergone to collect sera from unvaccinated survivors and vaccinated persons--with and without COVID-19 pre-infection. The sera were analyzed for the anti-Receptor Binding Domain (RBD) titers by ELISA and for the capacity to neutralize the pseudovirus of the Wuhan-Hu-1 strain by luciferase assays; (3) Results; Neither the antibody titers nor the neutralization capacity was significantly different between the three groups. However, the correlation between the antibody titers and the percentage of viral neutralization derived from sera of unvaccinated survivors was higher than that from vaccinated persons with pre-infection (Spearman correlation coefficient (r) = -0.8558; 95% CI, -0.9259 to -0.7288), p &lt;0.0001 vs -0. 581; 95% CI, -0.7679 to -0.3028; p = 0.0002, respectively), indicating the capacity to neutralize the virus is better among the unvaccinated individuals. (4) Conclusions: Vaccines induced anti-RBD titers as high as the natural infection with lower neutralization capacity, and it did not boost the immunity in pre-infected persons.

Mental health impacts of COVID-19 pandemic have received a great deal of attention by policymakers for the management of present and future cases of the pandemic, especially as new COVID-19 variant cases are on the rise. Thus, this study seeks to conduct a systematic review to address the following research questions: (1) What are the mental health impacts of COVID-19 in the empirical literature? (2) Which categories of people are at higher risk of the mental health impacts of the pandemic based on the extant literature? A sample of 35 studies out of 196 potential studies (from various databases, including Scopus, Google Scholar, , Research Gate, PubMed, , and libraries, from 2020 to 2022) were used after a comprehensive literature search and thorough assessment based on PRISMA-P guidelines. The study reveals that the pandemic has led to severe cases of mental health challenges such as depression, anxiety, post-traumatic stress disorder, psychological disorders, mood disorders, and insomnia. The review identified groups such as health workers, patients with pre-existing psychiatric or mental health issues, COVID-19 survivors, patients with underlying health conditions, and the elderly as the most vulnerable groups to mental health challenges from the pandemic.

The COVID-19 pandemic cost 7-8 million deaths worldwide, creating an unprecedented health and economic crisis. Affecting 700 million people globally, the magnitude of this pandemic is far from anything that humanity has encountered in recent times. A detailed investigation revealed that more than the SARS-CoV2 virus, the hyperactive immune system mediated injury as the real cause of mortality. Cytokine storm following viral infection leads to the surge of proinflammatory cytokines resulting in ARDS and lung injury. Anti-inflammatory intervention with anti-IL6 (anti-IL-6 receptor monoclonal antibodies (mAbs) (e.g., sarilumab, tocilizumab) and anti-IL-6 mAbs (i.e., siltuximab) and /or steroid-based approach lead to substantial protection and prevent death thereby implying the role of inflammation in COVID-19. In this short review, we summarized the dysregulated immune system in COVID-19 infection, investigating in detail the virus–host immune cross talks and presenting the possibilities of therapeutic intervention.

Introduction: This study aims to investigate the activity of the remdesivir-nirmatrelvir combination against Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and to report a case of Coronavirus Disease 2019 (COVID-19) cured with this combination. Methods: A Vero E6 cell-based infection assay was used to investigate the in vitro activity of the remdesivir-nirmatrelvir combination. The SARS-CoV-2 strains tested were 20A.EU1, BA.1 and BA.5. After incubation, a viability assay was performed. The supernatants were collected and used for viral titration. The Highest Single Agent (HSA) reference model was calculated. An HSA score >10 is considered synergic. Results: Remdesivir and nirmatrelvir showed synergistic activity at 48 and 72 h with an HSA score of 52.8 and 28.6, respectively (p<0.0001). This data has been confirmed performing supernatant titration and against the omicron variants: the combination reduced the viral titer better than the more active compound alone. An immunocompromised patient with prolonged and critical COVID-19 was successfully treated with remdesivir, nirmatrelvir/ritonavir, tixagevimab/cilgavimab, and dexamethasone, with an excellent clinical-radiological response. However, she required further off-label prolonged therapy with nirmatrelvir/ritonavir up to the negativization. Conclusion: Remdesivir-nirmatrelvir combination has synergic activity in vitro. This combination may have a role in immunosuppressed patients with severe COVID-19 and prolonged viral shedding.

The emergence of the SARS-CoV-2 Variant of Concern (VOC) Omicron has been characterized by an explosive number of cases in almost every part of the world. The dissemination of different sub-lineages and recombinant genomes also led to several posterior waves in many countries. The circulation of this VOC and its major sub-lineages (BA.1 to BA.5) was monitored in community cases and in international travelers returning to Venezuela, by a rapid partial sequencing method. The specific sub-lineage assignment was performed by complete genome sequencing. Epidemic waves of SARS-CoV-2 cases were observed among international travelers during 2022, a situation not seen before December 2021. The succession of the Omicron VOC sub-lineages BA.1 to BA.5 occurred sequentially, except for BA.3, which was almost not detected. However, the sub-lineages generally circulated two months earlier in international travelers than in community cases. The diversity of Omicron sub-lineages found in international travelers was related to the one found in the USA, consistent with the most frequent destination of international travel from Venezuela this year. These differences are compatible with the delay observed in Latin American countries in the circulation of the different lineages of the Omicron VOC.

Identifying the psychological impacts of the COVID-19 pandemic on the general population can help with planning and preparing for future pandemics. The main objective of the current study was to examine the psychological impacts of the COVID-19 pandemic among Iranian citizens in 2021. The current study used an online cross-sectional survey via web-based questionnaires among Iranian citizens. Perceived feelings during the COVID-19 pandemic were measured by the validated self-reported inventory by Reynolds et al, 2007. The collected data were analyzed using descriptive statistics, including percent, mean, and standard deviation, as well as inferential statistics, including, correlation, chi-square, independent t-test, and analysis of variances (ANOVA) by SPSS.22. The average age of the respondents was 34.62 (±11.86). The most frequent feelings experienced by Iranian citizens were boredom (44.0%), nostalgia (40.6%), anxiety (35.3%), and nervousness (34.1%). Female participants, younger respondents, unemployed, single individuals, and those living in the urban areas experienced significantly higher levels of the negative feelings. The results of the study showed the high prevalence of the psychological effects of the COVID-19 pandemic in Iranian citizens, particularly among women, single, and unemployed people. Therefore, we need to develop more supportive and consultative packages for future pandemics as well as implement psychological rehabilitation after the crises.

This study examines the negative impacts of dark stores on the urban environment from three perspectives: land use, transportation, and streetscape. It is conducted on B-Mart, a representative dark store in South Korea. First, in terms of land use, we find that dark stores that function as logistics facilities conflict with the surrounding land use. Second, by analyzing the location of dark stores and the hourly traffic volume of delivery vehicles, we find that the impact on the surrounding transportation infrastructure and pedestrian traffic is not as significant as previously claimed. However, during the transportation and loading process of the dark store, several problems such as traffic violations, illegal parking, and illegal loading were observed, posing a risk to nearby vehicles and pedestrians. Third, in terms of streetscapes, the location of dark stores on the ground floor of buildings can harm streetscapes. The current urban planning system in South Korea does not clearly define the status and function of dark stores, making it unclear how to manage them. Therefore, it is necessary to clarify their legal definition and introduce urban planning and design guidelines that are consistent with their appropriate location and appearance.

The COVID-19 pandemic is one of the past century's deadliest and most widespread viral outbreaks, with higher mortality rates in men than women. Disruptions in funeral rituals and customs, no social recognition of the loss, and limited social support intricate the grieving process and are linked with disenfranchised (not openly acknowledged, socially recognized, or publicly mourned) grief. Depression is also highly comorbid with complicated grief. Losing a spouse can be devastating, but more severe for women with limited or no resources, vulnerable to the patriarchal society. In the current COVID-19 era, increased uncertainty and disenfranchised grief can worsen the clinical scenario and intervention, as highlighted by the present case report of disenfranchised grief with depressive symptoms in a 30 years old woman from rural India who, after a year of her marriage, lost her husband due to COVID-19. This case study emphasizes the impact of multiple axes of disadvantages due to sociodemographic and cultural determinants that can complicate the grieving process in the current context. The bioecological model of grief recovery considered the individual features and the societal/environmental factors to postulate the appropriate intervention. Finding meaning and purpose in life, and restoration-oriented coping were successful for clinical management.

(1) Background: This paper investigates the epidemiological risk related to temperature before and during COVID-19 in Italy; (2) Methods: Deaths in 2015-2019 and temperatures were correlated. Excess and COVID-19 deaths were examined to estimate the relationships with temperatures; (3) Results: Annual deaths were higher during the cold months (+45,000, SD = 4,700, S = 21). The scenario worsened during COVID-19. Mortality was higher during minimum temperature periods, although the curve moderately rose in the warmest months (r = -0.75, 95% CI = [-0.87; -0.56], S = 23). COVID-19 deaths showed a decreasing seasonality. Monthly excess deaths during COVID-19 were high (+4,200, IQR = [2,800; 8,000], S = 28) with a doubt of seasonality. COVID-19 mortality was correlated with regional latitude (r = 0.86, 95% CI = [0.68; 0.94], S = 20). Discrepancies between COVID-19 and excess deaths were found. The exposed population was subject to aging; (4) Conclusions: The epidemiological risk in Italy is seasonal and geographically dependent. Low and very high temperatures can lead to mortality peaks. Therefore, COVID-19 and any other epidemiological risk must be evaluated in light of this evidence. Health systems need to be strengthened during cold and extremely hot periods. Future research should investigate these phenomena at the causal level.

Interpretive Structural Modelling (ISM) is widely used to understand the complex connections between different components. This study presents a bibliometric overview of ISM research with a focus on its linkages to the Sustainable Development Goals (SDG) and the impact of COVID-19. The study analyzed 1988 publications on ISM published between 2012 and 2021, of which 1202 were directly mapped to the SDG and 59 were related to COVID-19. The study identified key authors, institutions, countries, and journals involved in the research and their linkages to the SDG. The results showed that ISM research is strongly linked to SDG 12 (Responsible Consumption and Production) and SDG 9 (Industry, Innovation and Infrastructure). We also identified influential SDG based on centrality measures like betweenness and eigenvector. The top four countries contributing to ISM publications were India, China, the United Kingdom, and the United States. The most frequently cited journals were Benchmarking: An International Journal, Sustainability, Journal of Modelling in Management, and Journal of Cleaner Production. Four main clusters were identified in the ISM research, including (1) integration with AHP & Fuzzy Logic for promoting sustainability alignment, (2) ISM-based strategy development for various stakeholders, (3) ISM-based decision-making in various fields, and (4) ISM-based risk evaluation. For the first time studies that used ISM approach to understand the epidemiological characteristics of COVID-19 were identified and their key findings were discussed. The study also identified several emerging topics for future ISM research, such as blockchain & IoT, environmental management systems, climate change adaptation, smart cities, and humanitarian logistics and their potential linkages to SDG.

Predicting Length of Stay (LoS) and understanding its underlying factors is essential to minimize the risk of hospital-acquired conditions, improve financial, operational, and clinical outcomes, and to better manage future pandemics. The purpose of this study is to forecast patients’ LoS using a deep learning model and analyze cohorts of risk factors minimizing or maximizing LoS. We employed various pre-processing techniques, SMOTE-N to balance data, and Tab-Transformer model to forecast LoS. Finally, Apriori algorithm was applied to analyze cohorts of risk factors influencing LoS at hospital. The Tab-Transformer outperformed the base Machine Learning models with an F1-score (.92), precision (.83), recall (.93), and accuracy (.73) for discharge dataset, and F1-score (.84), precision (.75), recall (.98), and accuracy (.77) for deceased dataset. The association mining algorithm was able to identify significant risk factors/indicators belonging to lab, X-Ray, and clinical data such as elevated LDH, and D-Dimer, lymphocytes count, and comorbidities such as hypertension and diabetes responsible for extending patients LoS. It also reveals what treatments has reduced the symptoms of COVID-19 patients leading to reduction in LoS particularly when no vaccines or medication such as Paxlovid were available.

Abstract: Background: Stigma in health can result in a broad range of vulnerabilities and risk for patients and healthcare providers. The media plays a role in people’s understanding of health and stigma is socially constructed through many communication channels including via media framing. Among health issues that were affected by stigma recently were the Monkeypox and Covid-19. Objectives: This research aims to examine how The Washington Post framed stigma around mon-keypox and COVID-19. Guided by the framing theory and stigma theory, online news coverage for monkeypox and COVID-19 were analyzed to understand the construction of social stigma through the media reporting. Methods: This research employed a qualitative content analysis to compare news framing in The Washington Post online news regarding monkeypox and COVID-19. Results: Based on endemic, reassurance, and sexual transmission frames, the The Washington Post predominantly defined Africa as the source of the disease, blames gay communities, and empha-sizes no need to worry about the spread of the monkeypox virus. For the COVID-19 coverage, The Washington Post described China as the source of the coronavirus and constructs the image of panic towards the spread of the virus. Conclusions: The shifts in stigma discourse essentially manifest racism, xenophobia, and sexism in public health. This research affirms that the media reinforces stigma phenomenon in health through framing and offers constructive suggestions for mitigating this issue.

Currently SARS-CoV-2 is spreading around the world as an Omicron strain. Recently, the Omicron variants (BQ.1 and BQ.1.1) were identified as novel Variants of Concern. UpToDate, there is little information about the Omicron Variants BQ.1 and BQ.1.1. The widely altered Omicron variants are spread globally, providing a high risk of infection surges with devastating consequences in some areas. The Omicron type of SARS-CoV-2 has a harm risk of reinfection, according to early reported findings. COVID-19 Variants particularly, BQ.1 and BQ.1.1 have gained global attention and caused a worldwide sensation since their discovery. Therefore, this communication discusses the present status of COVID-19 Variants BQ.1 and BQ.1.1, and their consequences.

This research investigates a model for the COVID-19 outbreak in Indonesia by analyzing comorbid diseases, self-quarantine, government-provided quarantine, and immunization regimens. Some model parameters are derived from academic journals, others are extrapolated from data collected by the Indonesian Ministry of Health in 2020, and others are assumed. Evaluation of the model reveals non-endemic equilibrium points, endemic equilibrium points, and the basic reproduction number (BRN). The contact rate and infected probability factors impact the increase in the number of COVID-19-infected individuals with comorbid disease within a group. According to the sensitivity analysis of the BRN, the key parameters impacting the spread of COVID-19 are the rate of susceptible recruitment, the rate of contact, the COVID-19 infection death rate, and the likelihood of infection. In addition, sensitivity analyses are provided to examine the effect of parameter changes on subpopulations. We discovered that the natural death rate is the most sensitive parameter based on the sensitivity index after reaching equilibrium. Symmetry aspects appear in some of the visualization of the model’s solution and the BRN and parameters’ sensitivity.

Objective: to assess level of trust in health services during COVID-19 pandemic in Brazil. Methods: Cross-sectional study, carried out between 2020 and 2021, among Brazilians over 18. A non-probabilistic sampling was used. Descriptive and inferential statistics were applied, using the Local Bivariate Moran’s technique was used to verify the existence of spatial dependence between the incidence and mortality of COVID-19 and trust in health services. Furthermore, multinomial regression was also used to analyze the factors associated with the confidence level, with the calculation of the Odds Ratio and with a confidence interval of 95%. Results: 50.6% reported trust in hospital services while 41.4% did not trust Primary Health Care services. With the application of the Local Bivariate Moran, both for the incidence and mortality of COVID-19, the trust in tertiary care and primary care services showed a statistically significant spatial association predominant in the Midwest (High-Low) and North (Low-High) regions of Brazil. The level of trust was associated with education, religion, region of the country and income. Conclusions: The level of trust in hospital services, more than Primary Health Care services, may be related to the population's culture of prioritizing the search for hospital care at the detriment of health promotion and disease prevention

COVID-19 is the most severe health crisis of the 21st century. COVID-19 presents a threat to almost all countries world-wide. The restriction of human mobility is one of the strategies used to control the transmission of COVID-19. However, it has yet to be determined how effective this restriction is in controlling the rise in COVID-19 cases, particularly in major capital cities such as Jakarta, Indonesia. Using Facebook's mobility data, our study explores the impact of restricting human mobility on COVID-19 case control in Jakarta. Our main contribution is showing how the restriction of human mobility data can give important information about how COVID-19 spreads in different places. We proposed modifying a global regression model into a local regression model by accounting for the spatial and temporal interdependence of COVID-19 transmission across space and time. We applied Bayesian hierarchical Poisson spatiotemporal models with spatially varying regression coefficients. We estimated the regression parameters using an Integrated Nested Laplace Approximation. We found that the local regression model with spatially varying regression coefficients outperforms the global regression model based on DIC, WAIC, MPL, and R2 criteria for model selection. In Jakarta's 44 districts, the impact of human mobility varies significantly. The impacts of human mobility on the log relative risk of COVID-19 range from –4.445 to 2.353. The prevention strategy involving the restriction of human mobility may be beneficial in some districts but ineffective in others. Therefore, a cost-effective strategy had to be adopted.

Introduction: The COVID-19 pandemic overwhelmed health systems globally, and affected delivery of other health services. We conducted a study in Uganda to describe interventions for continuity of access to other health services. Methods: We reviewed documents and interviewed 21 key informants. Thematic analysis was conducted to identify themes using the World Health Organization health system building blocks as a guiding framework. Results: Governance strategies included establishment of coordination committees and development and dissemination of guidelines. Infrastructure and commodities strategies included review of drug supply plans and allowing emergency orders. Workforce strategies included provision of infection prevention and control equipment, recruitment and provision of incentives. Service delivery modifications included designation of facilities for COVID-19 management, patient self-management, dispensing drugs for longer periods and leveraging community patient networks to distribute medicines. However, multi-month drug dispensing led to drug stock-outs while community drug distribution was associated with stigma concerns. Conclusions: Health service maintenance during emergencies requires coordination to harness existing health system investments. The service continuity committee coordinated efforts to maintain services and should remain a critical element of emergency response. Self-management and leveraging patient networks should address stigma to support service continuity in similar settings and strengthen service delivery beyond the pandemic.

COVID-19, the infectious disease caused by SARS-CoV-2, has spread on a pandemic scale. The virus infection can evolve asymptomatically or generate severe symptoms, influenced by the presence of comorbidities. Lymphopenia in patients affected with COVID-19 according to the severity of symptoms is frequent. However, the profile of CD4+ and CD8+ T-cells regarding cytotoxicity and antiviral factor expression has not yet been completely elucidated in acute SARS-CoV-2 infections. The purpose of this study is to evaluate the phenotypic and functional profile of T-lymphocytes in patients with moderate and severe/critical COVID-19. During this pandemic period, we analyzed a cohort of 62 confirmed patients with SARS-CoV-2 (22 moderate cases and 40 severe/critical cases). Albeit lymphopenia, we observed an increase in the expression of CD28, co-stimulator molecule, and activation markers (CD38 and HLA-DR) in T-lymphocytes as well as an increase in the frequency of CD4+ T-cells, CD8+ T-cells, and NK cells that express the immunological checkpoint protein, PD-1, in patients with severe/critical condition compared to healthy controls. Regarding the cytotoxic profile of peripheral blood mononuclear cells, an increase in the response of CD4+ T-cells already at baseline level was observed, scarcely changed upon PMA and Ionomycin stimulation. Meanwhile, CD8+ T-lymphocytes decreased cytotoxic response, evidencing a profile of exhaustion in patients with severe COVID-19. As observed in the t-SNE technique CD4+ T-cytotoxic and CD8+ T with low granzyme production evidencing their dysfunctionality in severe/critical conditions. In addition, purified CD8+ T-lymphocytes from patients with severe COVID-19 showed an increased constitutive expression of differentially expressed genes associated with the caspase pathway, inflammasome, and antiviral factors, and curiously, reduced expression of TNF-α. The cytotoxic profile, by CD4+ T-cells, may compensate for the dysfunction/exhaustion of TCD8+ in acute SARS-CoV-2 infection. These findings may provide an understanding of the interplay of cytotoxicity between CD4+ T-cells and CD8+ T-cells in the severity of acute COVID-19 infection.

In the context of the pandemic caused by Covid-19, an important aspect that was affected and changed was the way people communicate. Communication efficiency can be improved by using modern technologies, for example: mobile devices, digital audio and video platforms, text platforms, social media and more. For further economic success, digital skills are needed not only for executives, but also for managers, in order to be able to lead teams and avoid situations of stress and tension in the virtual environment. This scientific paper includes a primary research of how the pandemic affected the communication at the workplace. For this a qualitative analysis was first performed, in which the interview was used as a working tool. Next, on the basis of a questionnaire, a hypothesis was formulated and validated afterwards through multiple linear regression. This research highlighted the particularly important role of communication and, in this context, the role of the remote team leader. In order to keep the team motivated and interested in the virtual environment, the manager must use modern tools to motivate, support and express his appreciation when the team, respectively the members of his team, achieve their goals successfully.

Background: Myometrial invasion (MI) is a parameter currently used in transvaginal ultrasound (TVS) in endometrial cancer (EC) to determine local staging, however, without molecular diagnostics, it is insufficient for selection of high-risk cases, i.e., those with a high risk of lymph node metastases (LNM). Methods: One hundred sixteen consecutive EC patients, who had received 2D transvaginal ultrasound examinations in their preoperative workup and final histopathology results as a reference standard, were included in this prospective study. Univariate and multivariate logistic models of analyzed TVS biomarkers (tumor [T] size, T area [AREA], T volume [SPE-VOL], MI, T-free distance to serosa [TFD], endo-myometrial irregularity, [EMIR], cervical stromal involvement, CSI) were evaluated to assess the relative accuracy of the possible LNM predictors. To avoid a potential bias in assuming linear relations between LNM and continuous predictors, spline functions were applied. Calculations were made in R with the use of libraries splines, glmulti, and pROC. Results: LNM was found in 20 out of 116 (17%) patients. In univariate analysis, only uMI, EMIR, uCSI and uTFD were significant predictors of LNM. Accuracy was 0.707 (AUC 0.684, 95% CI 0.568-0.801) for uMI (p<0.01), 0.672 (AUC 0.664, 95% CI 0.547-0.781) for EMIR (p<0.01), 0.776 (AUC 0.647, 95% CI 0.529-0.765) for uCSI (p<0.01), and 0.638 (AUC 0.683, 95% CI 0.563-0.803) for uTFD (p<0.05). The cut-off value for uTFD was 5.2 mm. However, AREA and VOL revealed significant relation by non-linear analysis as well. Among all possible multivariate models, the one comprising interactions of splines of uTFD with uMI and splines of SPE-VOL with uCSI showed most usefulness. Accuracy was 0.802 (AUC 0.791, 95% CI 0.673-0.91) Conclusions: A combination of uTFD for patients with uMI>50%, and SPE-VOL for patients with uCSI, allows for the most accurate prediction of LNM in EC, rather than uMI alone.

On 17 June 2022, the U.S. FDA authorized the Pfizer-BioNTech and Moderna COVID-19 (SARS-CoV-2) vaccines for emergency use in children ages 6 months – 4 years. Seroprevalence has increased during the current Omicron variant wave for children under 5 years and the burden of hospitalization for this age group is similar or exceeds other pediatric vaccine preventable diseases. Research following the October 2021 approval of vaccines for children 5 – 11 indicates high prevalence of parental vaccine hesitancy and low uptake, underscoring the urgency of understanding attitudes and beliefs driving parental COVID-19 vaccine rejection and acceptance for younger children. One month prior to FDA approval, in the present study 411 U.S. female guardians of children 1 – 4 years from diverse racial/ethnic, economic, and geographic backgrounds participated in a mixed method online survey assessing determinants of COVID-19 pediatric vaccine hesitancy. Only 31.3% of parents intended to vaccinate their child, 22.6% were unsure, and 46.2% intended not to vaccinate. Logistic regression indicated significant barriers to vaccination uptake including: Concerns about immediate and long-term vaccination side effects for young children, the rushed nature of FDA approval and distrust in government and pharmaceutical companies, lack of community and family support for pediatric vaccination, conflicting media messaging, and lower socioeconomic status. Vaccine-resistant and unsure parents were also more likely to believe children were not susceptible to infection and that the vaccine no longer worked against new variants. Findings underscore the need for improved public health messaging and transparency regarding vaccine development and approval, the importance of community outreach, and increased pediatrician attention to parental concerns to better improve COVID vaccine uptake for young children.

COVID-19 vaccine hesitancy is considered responsible for the lower rate of acceptance of vaccines in many parts of the world. However, sources of this hesitancy are rooted in many social, political, and economic factors. This paper strives to find the most important variables in predicting the COVID-19 vaccination uptake. We introduce an explainable machine learning (ML) framework to understand the COVID-19 vaccination uptake around the world. To predict vaccination uptake, we have trained a random forest (RF) regression model using a number of sociodemographic and socioeconomic data. The traditional decision tree (DT) regression model is also implemented as the baseline model. We found that the RF model performed better than the DT model since RF is more robust to handle nonlinearity and multi-collinearity. Also, we have presented feature importance based on impurity measure, permutation, and Shapley values to provide the most significant unbiased features. It is found that electrification coverage and Gross Domestic Product are the strongest predictors for higher vaccination uptake, whereas the Fragile state index (FI) contributed to lower vaccination uptake. These findings suggest addressing issues that are found responsible for lower vaccination uptake to combat any future public health crisis.

The full impact of COVID-19 on policing, crime and disorder is slowly being fully unraveled. However, there remains a number of areas of policing that are yet to be examined in detail. Two of these areas include the impact on the intrinsically linked, volume of police recorded intelligence reports, and the use of stop and search. In this study we examine them symbiotically and frame them in the context of the intelligence led policing model, in particular in an effort to understand how national lockdowns in the United Kingdom affected both proactive policing approaches and the underpinning intelligence cycle. To achieve this, we use data from freedom of information requests regarding the annual levels of recorded police intelligence over a 10-year period for 20 police services. To supplement this, we examine overall national monthly volumes of stop and search activity over a 5-year period. Finally, we then use a case study approach of 3 police services to further explore changes in the conduct of stop and search such as the officer defined ethnicity, grounds for search and disposal outcomes. The findings indicate that both recorded intelligence reports and stop and search increased dramatically during periods of lockdown, despite widespread decreases in crime and social mobility. Changes in proportional impact are identified for White and Black citizens, searches for controlled drugs and the no further action disposal, but these are not consistent across police services. Potential causes and implications are then discussed and again, framed within the context of the impact on the intelligence led policing model and wider policing environment.

Background: While several drugs are in the pipeline for treatment of various grades of COVID-19 disease, none of them have shown promise until now. Medicinal plants are crucial in developing and developed countries for their primary and basic health needs owing to better tolerability, superior compatibility with human body and having lesser side effects. AEV01 , a speciality extract of kutki (Picrorhiza kurroa), is one potential medicinal herb which can be effective for mild COVID19 in elderly patients at risk of complications and aging immunity. Purpose: The efficacy and safety of AEV01 for mild COVID-19 in elderly patients at risk of complications was investigated in this study. Study design: A prospective, phase 3, randomized, multicentric, placebo controlled double blinded parallel group interventional trial. Methods: This study was conducted in elderly patients diagnosed as COVID-19 with mild symptoms. 70 patients were randomized into two groups to receive AEV01 capsule (100mg) and placebo respectively thrice daily for 30 days along with standard care of treatment as per national WHO/ICMR guidelines. Clinical improvement timelines and corresponding scores using 8-point ordinal scale and NEWS were assessed for efficacy and safety of AEV01 in COVID-19 patients. Results: AEV01 group showed a significant improvement (P=0.0001) in the normalization of the SpO₂ rate and relief from cough. There was also significant difference in time to recovery, with patients in the AEV01 drugtreated group recovering in 4.5 days as compared to Placebo in 9.1 days. ESR, LDH, serum ferritin, Neutrophil-Lymphocyte ratio (NLR), TNF- alpha, IL-6 and CD4 cell counts, which are considered as prognostic markers in COVID19 infected patients, showed a significant improvement in patients treated with AEV01. The AEV01 drug treated group showed significant clinical improvement in the 8-point ordinal scale severity rating and NEW Score from day 3 onwards which continued up to end of study. Conclusion: AEV01 has shown a significant improvement in clinical and laboratory parameters. There was also reduction in the progression of the COVID-19 disease in unvaccinated elderly patients from mild to moderate when treated at an earlier stage.

Objective: To investigate postacute laryngeal injuries and dysfunctions (PLID) in coronavirus disease 2019 (COVID-19) patients. Methods: Three independent investigators performed a systematic review of the current literature studying PLID in patients with a history of COVID-19. The review was performed according to PRISMA Statement. Epidemiological, clinical, hospitalization features, laryngeal diseases and voice outcomes were extracted from the included papers. Results: Eight papers met our inclusion criteria (393 patients) corresponding to 5 uncontrolled prospective and 3 retrospective studies. The most prevalent PLID were vocal fold dysmotility (65%), vocal fold edema (35%), laryngopharyngeal reflux (21%), and muscle tension dysphonia (21%). Posterior glottic stenosis (12%), granuloma (14%), and posterior glottic diastasis (12%) were the most common injuries. Most patients with PLID were obese and had a history of intensive care unit hospitalization, and orotracheal intubation. The delay between the discharge and the laryngology office consultation ranged from 51 to 122 days. The mean duration of intubation ranged from 10 to 34 days. Seventy-eight (49%) intubated patients were in prone position. The proportion of patients requiring surgical treatment ranged from 39% to 70% (mean=48%). There was an important heterogeneity between studies about inclusion, exclusion criteria and outcomes. Conclusion: COVID-19 appeared to be associated with PLID, especially in patients with a history of intubation. However, future controlled studies are needed to evaluate if intubated COVID-19 patients reported more frequently PLID than patients who were intubated for other conditions.

Background: As coronavirus (COVID-19) continues to pose a threat to the entire world, it is critical to developing strategies for containing its spread. The purpose of this study was to assess the demographic characteristics, brain tomography characteristics, and diffusion magnetic resonance findings of COVID-19 positive individuals. Material and Method: Between January 1 and December 31, 2021, 317 patients over the age of 18 were admitted to the emergency department with symptoms consistent with COVID-19. Three groups were formed based on clinical findings in patients, divided into light, medium, and severe, and four groups were formed based on radiological imaging findings. Results: The mean age of the 317 patients included in the study was 67.28±12.06 years, with a range of 28-91 years. The clinical classification of the patients was based on laboratory parameters and radiological imaging, not on their age or gender. Mild cases were classified as CO-RADS 0-4; moderate and severe cases were classified as CO-RADS 5-6 (p=0.001). While 60 (18.9%) of patients were followed outpatient, 144 (45.4%) were admitted to the hospital, 73 (23%) were admitted to the intensive care unit, and 40 (12.7%) died (p=0.001). Direct radiographs revealed bilateral involvement in 224 (70.7%) cases, peripheral involvement in 259 (81.7%) cases, and mid-lower lobe lung involvement in 194 (61.2%) cases (p=0.001). Brain tomography revealed infarction in 42 (13.2%) of the patients who were followed and hospitalized and hemorrhage in 22 (6.9%) of the patients. Magnetic resonance imaging revealed diffusion involvement in 68 (21.5%) of the cases (p=0.001). Conclusion: A standardized reporting system for COVID-19 data is required, and it must be simple to use, quick to understand, and focused on determining the risk of pneumonia. Additionally, the diagnostic role of radiological imaging, prognosis prediction, and severity scoring of lung involvement should be included.

The worldwide outbreak of SARS-CoV-2 in early 2020 caused numer- ous deaths and unprecedented measures to control its spread. We employed our Computational Analysis of Novel Drug Opportunities (CANDO) multiscale therapeutic discovery, repurposing, and design platform to identify small molecule inhibitors of the virus to treat its resulting indication, COVID-19. Initially, few experimental studies existed on SARS-CoV-2, so we optimized our drug candidate prediction pipelines using results from two independent high-throughput screens against prevalent human coronaviruses. Ranked lists of candidate drugs were generated using our open source cando.py software based on viral protein inhibition and proteomic interaction similarity. For the former viral protein inhibition pipeline, we computed interaction scores between all compounds in the corresponding candidate library and eighteen SARS-CoV proteins using an interaction scoring protocol with extensive parameter optimization which was then applied to the SARS-CoV-2 proteome for prediction. For the latter similarity based pipeline, we computed interaction scores between all compounds and human protein structures in our libraries then used a consensus scoring approach to identify candidates with highly similar proteomic interaction signatures to multiple known anti-coronavirus actives. We published our ranked candidate lists at the very beginning of the COVID-19 pandemic. Since then, 51 of our 276 predictions have demonstrated anti-SARS-CoV-2 activity in published clinical and experimental studies. These results illustrate the ability our platform to rapidly respond to emergent pathogens and provide greater evidence that treating compounds in a multitarget context more accurately describes their behavior in biological systems.

Objective: To evaluate the effect of rectal Ozone (O3) in severe COVID-19 pneumonia in two different cohorts differing in location (Madrid vs Zilina), ethnicity (Slovakian vs Spanish cohorts) and age. Material and Methods: In a multicenter-study, 32 severe bilateral-COVID-19-pneumonia patients and (+) RT-PCR (reverse transcriptase polymerase chain reaction) SARS-CoV-2 were evaluated (16 from each cohort). Primary outcomes: a) clinical (O2-saturation); b) biochemical (Lymphocyte-count, Fibrinogen, D-Dimer, Urea, Ferritin, LDH [lactate dehydrigenase], IL-6 and CRP [c-reactive protein]); and c) radiological improvement. Secondary outcomes: a) days-of-hospitalization, b) mortality-rate before discharge. The Ozone-protocol consisted of 10 sessions of intra-rectal Ozone, total dose 5.25 mg (150 mL volume, 35 g/ml concentration). The Standard-of-care protocol included O2 supply, antivirals (Remdesivir / Isoprinosine), corticosteroids (Dexamethasone / Metilprednisolone), monoclonal antibodies (Anakinra / Tocilizumab), antibiotics (Azytromicine), anticoagulants (Enoxaparine / Fraxiparine). Protocol was approved by Health Care Ethics Committee (Report 15/4/2020) of our Hospital and by Ethics Committee for Medical Investigation of La Princesa’s Hospital (ACTA CEIm 12/20, 28/5/20, Registry 4146). Results: Patients in Slovakian cohort were younger (53.38 vs 84.69 years). Grade of severity was worse in Spanish-cohort (4.78 vs 3.30 points). Length of stay was superior in Spanish-cohort (27.38 vs 10.07 days). Both cohorts improved O2-saturation and Lymphocyte-count. Inflammation biomarkers (Fibrinogen, D-Dimer, Urea, Ferritin, LDH, CRP and IL-6) decreased in both cohorts. In Spanish-cohort, Urea and Ferritin improvement was not significant (p>0.05), while in Slovakian-cohort, Urea, Fibrinogen and LDH were not significant (p>0.05) Radiological signs of bilateral pneumonitis decreased on both cohorts. Mortality was similar (12.5%). Conclusion: After Standard of care protocol, Rectal Ozone improved O2-saturation, decreased inflammation biomarkers and improved Taylor’s radiological scale in both cohorts. Although age, grade of severity and days of hospitalization were inferior in Slovakian cohort, mortality was similar in both cohorts, but inferior if compared to an external control cohort.

(1) Background: in epidemiological terms, it has been possible to calculate the savings in health resources and the reduction in health effects of COVID vaccines. From the point of view of economic evaluation, some studies have estimated its cost-effectiveness with the vaccination showing highly favorable results, which in some cases is cost-saving; (2) Methods: a cost-benefit analysis of the vaccination campaign in the North Metropolitan Health Region (Catalonia). An epidemiological model based on observational data and before and after comparison is used. The information on the doses used and the resources assigned (conventional hospital beds, ICU, number of tests) has been extracted from administrative data from the largest Primary Care provider in the region (Catalan Institute of Health). A distinction is made between the social perspective and the health system; (3) Results: the costs of vaccination are estimated at 137 million euros (€48.05/dose administered). This figure is significantly lower than the positive impacts of the vaccination campaign, which are estimated at 470 million euros (€164/dose administered). Of these, 18% corresponds to the reduction of ICU discharges, 16% to the reduction in conventional hospital discharges, 5% to the reduction in PCR tests and 1% to the reduction of RAT tests. Monetization of deaths and cases with sequelae avoided account for 53% and 5% of total savings, respectively. The benefit/cost ratio is estimated at 3.4 from a social perspective and 1.41 from a health system perspective. The social benefits of vaccination are estimated at €116.67 per dose of vaccine given (€19.93 from the point of view of the health system); (4) Conclusions: the mass vaccination campaign against COVID is cost-saving. From a social perspective, most of these savings come from the monetization of the reduction in mortality and cases with sequelae, although the intervention is equally widely cost-effective from the point of view of the health system thanks to the reduction in the use of resources. It is concluded that, from an economic perspective, the vaccination campaign has high social returns.

Background: The cumulative number of patients during the COVID-19 pandemic led to a significant shortage of hospital beds. Many patients may not require hospitalization and can be clinically observed in home settings. However, some psychosocial factors are correlated with unsuccessful home isolation (HI), which might negatively affect the transmission control in the community. Therefore, we developed a new psychosocial screening tool (CCPHIET) for assessing HI suitability and examined its validity and reliability.Methods: This cross-sectional descriptive study included COVID-19 patients who were deemed to be medically safe for 14 days of HI. The CCPHIET is comprised of 8 clinical domains pertinent to HI behavioral compliance and risk. We explored its statistical validity and reliability and discussed the potential utility of this tool. Results: A total of 65 COVID-19 patients participated in this study. Most patients (58.5%) were evaluated as good candidates for HI. The CCPHIET has an acceptable content validity (IOC index > 0.5), moderate internal consistency (Cronbach’s alpha = 0.611) and substantial to excellent inter-rater reliability (Intraclass correlation coefficient = 0.944, Cohen’s kappa= 0.627).Conclusions: To compromise between strict and costly absolute institutional quarantine and the potentially unsuccessful absolute HI, the CCPHIET may help to identify good candidates for HI in mild and asymptomatic COVID-19 patients. This psychosocial information would support the physicians in matching each patient to the most suitable setting. Therefore, safe medical care is provided, unnecessary use of medical resources is spared, and local transmission is contained.

The present study measured household hunger in South-East Nigeria amidst COVID-19 lockdown. A total of 1209 households (urban and rural locations) were sampled. Household hunger was determined using Radimer/Cornel hunger scale, while Chi-square test was done with significance of P<0.05. Results of this study revealed 82.7% prevalence of hunger among households before Covid-19 pandemic, while during Covid-19 lockdown, hunger prevalence rose to 98.6%. It was also observed that covid-19 lockdown significantly affected food prices.The major coping strategy employed by households was relying on less expensive foods (81.14%). High household hunger was identified as a short term cost of Covid-19 lockdown in Southeast Nigeria. Only few households benefited from the food aid programs and other forms of palliatives by Government. It is recommended that the Government should setup a formidable unit which will develop physical and digital plans for effective implemention during Covid-19 lockdown situation or other emergencies.

The education system has become even more complex following the global pandemic, which saw face-to-face teaching transition to virtual teaching. To cope with this abrupt transition, it is essential that teachers had a sufficient level of digital teaching competence. This article aims to increase awareness of teachers' self-perception of their digital teaching competences in the educational field. Specifically, this study explores Spanish secondary school teachers’ knowledge and use of different ICT tools by evaluating their competence based on different areas proposed by The National Institute of Technology and Professional Development (Instituto Nacional de Tecnologías Educativas y de Formación del Profesorado, INTEF), Madrid, Spain. From the results of the questionnaires, we have determined that teachers consider themselves to have an upper intermediate level of digital teaching competence, although there are still shortcomings that need to be addressed in order to improve this level of competence, and its true integration in the teaching–learning process.

Health and wellness tourism should be particularly valued in the post-pandemic phase, as a stra-tegic product to enhance the population's well-being and quality of life indicators, at social, phys-ical, and environmental dimensions, with different proposals for specialized experiences that complement the destination's offer, positioning regions as health and wellness destinations. Thermal tourism should be encouraged, as a specific product, due to the innovation and diversi-fication observed in the services made available and the benefits recognized at different age levels of tourists and destinations communities. Considering the relevance of thermal springs and thermal tourists for tourism destinations image, positioning, and development, this research aims to identify the specific motivations of tourists to the practice of thermal tourism, to understand how the benefits that thermal tourists search for, and their sociodemographic profile influence the motivations, and how the motivations determine the travel characteristics. This research was de-veloped on the North and Centre of Portugal, for their relevance in the context of thermal springs and related tourism activities. To achieve the research objectives, a questionnaire survey was ap-plied to thermal tourists, through a non-probability by convenience sampling, using bivariate tests, such as Pearson’s chi-squared test, one-way ANOVA, and t-student. The results highlight that most respondents practiced thermal tourism due to leisure and relaxation benefits, such as the escape from daily stress, spend time with family, and being "pampered"; relaxation is the most valued motivation, followed by the search for psychological and physical wellbeing. The research found relations between the benefits expected by thermal tourists, and their travel characteristics such as the composition of the group, the general travel motivation, the thermal destination cho-sen, and the number of nights spent. In thermal tourism, new challenges emerge, demanding the development of strategies, products, and services responding to the needs of specific market segments.

A complete halt on all anthropogenic activities and human movement due to COVID-19 lockdown has provided a great opportunity to assess the impact of human activities on coastal marine ecosystems. The current study assessed the concentration of the metals in water samples of the largest brackish water lagoon of Asia; the Chilika lagoon in the state of Odisha, India between pre-COVID-19 and post-COVID-19 lockdown scenarios. Monthly water samples (n=30 stations) from 0.3 m depth were collected from three sectors of the lagoon seasonally; pre-monsoon, monsoon, and post-monsoon. In addition to various physical parameters [pH, salinity, alkalinity, (DO) dissolved oxygen, (TDS) total dissolved solids, and (EC) electrical conductivity] the collected water samples were analysed for 18 trace metals (Al, As, Ba, Be, Cd, Co, Cr, Cu, Fe, Mn, Mo, Ni, Pb, Sr, Th, Tl, U, V). Most of the physical parameters showed a significant variation between pre-and post-COVID-19 scenarios, except for pH and DO. The concentration of five metals (Be, Cd, Co, Ni, and Pb) remained below detection limits in all water samples. The impact of COVID-19 lockdown on the concentration of the metal in the water samples was noticed along with the three sectors of the lagoon. However, eight metals (Al, As, Cr, Fe, Mn, Th, U, and V) were significantly different between the COVID-19 scenarios and the remaining five metals were not statistically significant. The mean concentration of Al, As, Fe, Th, and V were higher in the pre-COVID-19 scenarios, whereas only Cr and Mn were higher in the post-COVID-19 scenarios. The mean concentration of U was similar among both COVID-19 scenarios, even though there were seasonal and sectoral differences. The seasonal influence of riverine influx was more evident on metal concentration during the monsoon season, whereas the difference between sectors was more prominent during the post-monsoon season. An increased number of correlations between physical parameters and metal concentration were observed in the post-monsoon season and post-COVID-19 scenario. This study provides evidence that the imposition of COVID-19 lockdown reduced metal influx in the water column and improved the water quality of the Chilika lagoon. Our results can be used as baseline for metal concentration in surface waters of the lagoon.

Background: The abrupt implementation of COVID-19 lockdown had impacted the management of diabetes mellitus. Limited access to health facilities and alterations in daily lifestyle put metabolic control among patients at risk. Thus, we observed the differences in metabolic control parameters in diabetic patients before and during the lockdown. Methods: We performed searches from five databases. Meta-analyses were done using random or fixed-effect approaches with glycemic control parameters (HbA1c, RBG, FBG, TIR, TAR, TBR) as primary outcomes. Mean difference (MD), Confidence Interval (CI), and p-value were calculated. Lipid profile presented as secondary outcome. Results: 21 studies with 3992 diabetic patients were included in the study. Meta-analysis presented an increase on HbA1c of T1D and T2D patients [MD=+0.06% (95%CI -0.10–0.23), I²=77%, p=0.45], TBR of T1D patients [MD=-0.05% (95%CI -0.38–0.28), I²=0%, p=0.77], FBG of T2D patients [MD=+3,47 mg/dL (95%CI 1.22–5.73), I²=0%, p=0.002], and lipid profile on qualitative analysis. However, TIR, TAR, and RBG of T1D patients were improved [MD=+3.52% (95%CI 0.29–6.74), I²=76%, p=0.03; MD=-3.36% (95%CI -6.48–-0.25), I²=75%, p=0.03; MD=-0.91 mg/dL (95%CI -4.52–6.34), I²=88%, p=0.74]. Conclusion: Lockdown enforcement did not worsen the glycemic control parameter in diabetic patients. Particular parameters inclined to improve during the lockdown.

Mucormycosis (previously called zygomycosis or phycomycosis), an aggressive, life-threatening infection is further aggravating the human health-impact of the devastating COVID-19 pandemic. Additionally, a great deal of mostly misleading discussion is focused also on the aggravation of the COVID-19 accrued impacts due to the white and yellow fungal diseases. In addition to the knowledge of important risk factors, modes of spread, pathogenesis and host defences, a critical discussion on the botanical insights into the main causative agents of mucormycosis in the current context is very imperative. Given above, in this paper: (i) general background of the mucormycosis and COVID-19 is briefly presented; (ii) overview of fungi is presented, the major beneficial and harmful fungi are highlighted; and also the major ways of fungal infections such as mycosis, mycotoxicosis, and mycetismus are enlightened; (iii) the major causative agents of mucormycosis are critically discussed; (iv) the systematic position, occurrence, structure, and the major modes of reproduction are summarized for Rhizopus sp. and Mucor sp., the major causative agents of mucormycosis; (v) the other causative agents of mucormycosis includes Cunninghamella bertholletiae, Apophysomyces elegans, Lichtheimia (Absidia), Saksenaea, and Rhizomucor pusillus are briefly introduced; (vi) facts related with the infection-misnomers based on fungi colour are also highlighted; and lastly, (vii) the major take-home message and clues for future research on the subject are listed.

Novel Coronavirus (2019-nCOV) causes inflammatory response with worsening symptoms. Classification of potential anti-viral and anti-inflammatory drugs in managing the symptoms of the COVID-19 and reducing morbidity is important. The objective of this study is to identify a group of drugs, best suited for COVID-19 treatment based on recent developments in clinical trials, FDA drug evaluation, directions and developments and from drug therapies globally. Online literature search was done on Medline, PubMed and google scholar databases for studies on various treatments and drug therapies for COVID-19 and relevant studies were identified and the identified drugs are described in detail as per their Pharmacological, pharmaceutical properties of the drugs, mechanism of action, current COVID-19 drug therapy, contraindications and drug-drug interactions Certain drugs can inhibit action against viral infection and protect lungs from severe inflammatory response. This article summarizes several drugs like Hydroxychloroquine, Chloroquine, Remdesivir, Favipiravir, Lopinavir, Ritonavir, Dexamethasone, Ivermectin, Baricitinib, Casirivimab / imdevimab, Bamlanivimab along with auxiliary treatment like convalescent plasma transfusion. Remdesivir is first drug approved by FDA. Hydroxychloroquine, dexamethasone and remdesivir are showing results against COVID-19 but it is important to test the efficacy and safety of such drugs though some drugs have shown remarkable results.

Here, we review findings and trends in sleep research in 2020-2021 demonstrating how COVID-19 and sleep disorders can induce the BBB leakage via neuroinflammation, which might contribute to the 'coronasomnia' phenomenon. The new studies suggest that the controlling of sleep hygiene and quality should be incorporated into the rehabilitation of COVID-19 patients. We also discuss perspective strategies for prevention of COVID-19-related BBB disorders. We demonstrate that sleep might be a novel biomarker of the BBB leakage and the analysis of sleep EEG patterns can be a breakthrough non-invasive technology for diagnosis of the COVID-19-caused BBB disruption.

Hadhramout Initiative Against Corona (HIAC ) formed a working group of clinicians relevant to the management of COVID-19 to formulate clinical practice guidelines (CPG) for clinicians caring for the patients infected with COVID-19 in Yemen. The regional guidelines on the management of COVID-19 were thoroughly reviewed and its applicability was assessed for Yemen. HIAC’s recommendations covered (2) sections: the first one is the diagnosis, including case definition, risk stratification of the affected cases, investigations (prioritization of reverse transcription-polymerase chain reaction (RT-PCR) testing, D-dimer, chest x-ray, and chest computed tomography, while the second part covers the treatments (mainly Favipiravir, Remdesivir, Hydroxychloroquine, and Glucocorticoid, Anticoagulants, and Supportive measures). In conclusion, the adoption of cost-effective and evidence-based guidelines in Yemen will standardize the management of the patients infected with COVID-19 and protect both the patients and the health care workers from malpractice.

IntroductionThe use of protective masks, especially medical masks, increased dramatically during the COVID-19 crisis. Medical masks are made of synthetic materials, mainly polypropylene, and a majority of them are produced in China and imported to the European market. The urgency of the need has so far prevailed over environmental considerations.ObjectiveAssess the environmental impact of different strategies for the use of facemaskMethod Different strategies for the use of medical and community masks are being investigated for their environmental impact in this study. 8 scenarios, differentiating the typologies of masks and the modes of reuse are compared using several environmental impact indicators, mainly the Global Warming Potential (GWP100), and the plastic leakage (PL). This study attempts to provide clear recommendations that consider both the environmental impact and the protective effectiveness of face masks used in the community.Results The environmental impact of single-use masks is the most unfavorable, with a GWP of 0.4 -1.3 kgCO₂ eq., depending on the transport scenario, and a PL of 1.8 g, for a one month protection against COVID-19. The use of home-made cotton masks and prolonged use of medical masks through wait-and-reuse are the scenarios with the lowest impact.ConclusionThe use of medical masks with a wait and reuse strategy seems to be the most appropriate when considering both environmental impact and effectiveness. Our results also highlight the need to develop procedures and the legal/operational framework to extend the use of protective equipment during a pandemic.

Prothrombotic thrombocytopathy mimicking heparin-induced thrombocytopenia has been observed in patients with severe COVID-19 and after immunisation with the Vaxzevria vaccine. Herein, we discuss the pathogenesis of this disorder focusing on the possible involvement of anti-platelet factor 4 (PF4) autoantibodies.

The recent SARS-CoV-2 pandemic, which is causing COVID 19 disease, has taught us unexpected lessons about the dangers of human extinction through highly contagious and lethal diseases. As the COVID 19 pandemic is now being controlled by various isolation measures, therapeutics and vaccines, it became clear that our current lifestyle and societal functions may not be sustainable in the long term. We now have to start thinking and planning on how to face the next dangerous pandemic, not just overcoming the one that is upon us now. Is there any evidence that even worse pandemics could strike us in the near future and threaten the existence of the human race? The answer is unequivocally yes. It is not necessary to get infected by viruses of bats, pangolins and other exotic animals that live in remote forests in order to be in danger. Creditable scientific evidence indicates that the human gut microbiota harbor billions of viruses which are capable of affecting the function of vital human organs such as the immune system, lung, brain, liver, kidney, heart etc. It is possible that the development of pathogenic variants in the gut can lead to contagious viruses which can cause pandemics, leading to destruction of vital organs, causing death or various debilitating diseases such as blindness, respiratory, liver, heart and kidney failures. These diseases could result n the complete shutdown of our civilization and probably the extinction of human race. In this essay, I will first provide a few independent pieces of scientific facts and then combine this information to come up with some (but certainly not all) hypothetical scenarios that could cause human race misery, even extinction. I hope that these scary scenarios will trigger preventative measures that could reverse or delay the projected adverse outcomes.

In the ongoing Covid-19 pandemic, if a preventive restriction (PR), intended to arrest the transmission of the virus, is effective we expect a decrease in the rate of transmission. If an effective PR is lifted or relaxed, the rate may show some increase. We test this expectation in the history of PR imposition and relaxation in all countries based on available public database. We found marginal or no negative correlation between standing stringency index of PR and change in slope of the local curve. A change in stringency index was significantly negatively correlated with change in slope, but change in stringency of PRs could explain only 6.1 percent of the variance in rates of transmission. The distribution of slope changes after imposing versus after relaxing PRs was highly overlapping with only a tail consisting of 4.5 % PR impositions being clearly non-overlapping with PR relaxation. Non-parametrically, only 9.4% of PR impositions were associated with a reduction in the slope above the expectation of a null hypothesis. In brief, globally, preventive restrictions have played a very small role in the pandemic process over the one year period. This feedback needs to be considered in making policy for disease prevention in the further course of the pandemic as well as in any future threats of respiratory disease epidemics.

Treatment with calcitriol, the hormonal form of vitamin D, has shown beneficial effects in ex-perimental models of acute lung injury. In this study we aimed to analyze the associations be-tween calcitriol supplementation and the risk of SARS-CoV2 infection or COVID-19 mortality. Individuals ≥18 years old living in Catalonia and supplemented with calcitriol from April 2019 to February 2020 were compared with propensity score matched controls. Outcome variables were SARS-CoV2 infection, severe COVID-19 and COVID-19 mortality. Associations between calcitriol supplementation and outcome variables were analyzed using multivariable Cox proportional regression. A total of 8076 patients were identified as being on calcitriol treatment. Advanced chronic kidney disease and hypoparathyroidism were the most frequent reasons for calcitriol supplementation in our population. Calcitriol use was associated with reduced risk of SARS-CoV2 infection (HR 0.78 [CI 95% 0.64-0.94], p=0.010), reduced risk of severe COVID-19 and reduced COVID-19 mortality (HR 0.57 (CI 95% 0.41-0.80), p=0.001) in patients with advanced chronic kidney disease. In addition, an inverse association between mean daily calcitriol dose and COVID-19 severity or mortality was observed in treated patients, independently of renal function. Our findings point out that patients with advanced chronic kidney disease could benefit from calcitriol supplementation during the COVID-19 pandemic.

The purpose of this research has been to provide information about the psychological effects of confinement forced by a prolonged quarantine in a suitable adult sample of 596 Bolivians of both sexes. It was sought to explore the perceptions of the participants about their own emotional state: fears, anxieties, depressions, while they were in isolation to reduce the probability of contagion of COVID 19. Additionally, we were interested in verifying the modulating effects of resilience and self-efficacy on such emotional states. The results indicated, in the same direction of similar studies, significant relationships between high perceived loneliness, high levels of stress and anxiety, with relatively high levels of depression. Likewise, it was clear that stress, perceived loneliness, and anxiety are predictors of depression among those in conditions of forced isolation. Finally, it was found that both resilience and self-efficacy exert a clear moderating effect by attenuating the relationships of perceived loneliness and anxiety, on depression.

The coronavirus pandemic (COVID-19) resulted in lockdowns and social distancing measures enforced by governments. Using a cross-sectional design, this study aimed to identify changes in adherence to the Mediterranean diet (MD) and physical activity (PA) and associations with personality, during lockdown in Qatar. A sample of 543 participants was recruited online between April and May 2020. Results showed a reduction in Mediterranean diet (MD) adherence during lockdown (5.9 ± 0.08) compared to before lockdown (6.1 ± 0.08) (p ˂ 0.001). Although there was an increase in the percentage of participants who consumed ≥4 tablespoons olive oil per day (9% vs 12%; p ˂ 0.001), vegetables (54.3% vs 58.7%; p = 0.005), legumes (11.8% vs 15.3%; p = 0.007) and sofrito (70.9% vs 77.3%; p ˂ 0.001), there was also a significant decrease in the percentage of participants who consumed fresh fruit (39.4% vs 15.8%; p ˂ 0.001) and fish/seafood (5.9% vs 3.9%; p = 0.035) and an increase in saturated fat consumption (45.9% vs 53.8%; p ˂ 0.001), during lockdown compared to before lockdown. Participants who scored high in the extraversion personality dimension had a higher MD adherence (B = 0.84; 95% CI = 0.04, 1.64; p = 0.039) before lockdown compared to participants who scored high in the agreeableness personality dimension, although this difference did not reach statistical significance during lockdown. Those who scored high in openness had the lowest change in MD adherence score (B = -0.31; 95% CI = -0.58, -0.04; p = 0.026). Total PA (B = -506.26; 95% CI = -678.60, -333.92; p ˂ 0.001), vigorous activity (B = -155.95; 95% CI = -274.64, - 38.21; p = 0.010), moderate activity (B = -93.04; 95% CI = -148.07, -38.01; p = 0.010) and walking (B = -257.27; 95% CI = -337.87, -176.67; p ˂ 0.001) were decreased during lockdown, while sitting was increased compared to before lockdown (B = 940.91, 95% CI = 831.9, 1049.90; p ˂ 0.001). Openness was positively associated with all PA (B = 562.2; 95% CI = 62.7, 106.7; p = 0.027), including walking (B = 241.7; 95 % CI = 29.4, 454.0; p = 0.026) and negatively associated with sitting (B= -303.4; 95% CI = -590.0; -16.8; p = 0.038) when compared to those with high agreeableness scores, before lockdown. During lockdown, the time spent sitting was lower in those with high scores on neuroticism when compared to those with high agreeableness scores (B= -619.5; 95 % CI = -1215,-23.9; p = 0.042). Differential changes in lifestyle habits by personality dimensions during lockdown, suggest the need to tailor lifestyle interventions based on people’s personality types, for more effective lifestyle change.

Purpose: Now traditional lecture-based teaching and learning have been affected by the COVID-19. The objectives of this article are to design the novel educational technique called ‘dynamic-based learning’ (DBL) that provides the combination of online teaching-learning methods and student’s creativity, to evaluate primary dynamic-based learning function, and to propose dynamic-based learning for higher education. Methods: DBL composes of four steps, including, preparation, homework, classroom, and evaluation, which was designed, and taught in medical and dental schools. Online support materials included mobile phone, email, Facebook Messenger, Line Messenger, Cisco Webex, and Zoom Meetings applications were recruited for this novel method. Results: A total of 32 third-year medical students and 26 sixth-year dental students was treated by DBL similarly. three subjects, including, Innovation in Dentistry, Basic Medical Research, and Principles of Pathology and Forensic Medicine were selected in this article. The results showed students could create their knowledge, ideas, and creativity during the online classes.Conclusion: DBL can be used as an alternative learning mode during the COVID-19 crisis. The benefits of DBL also include high flexibility, dynamic process, active learning, and high creativity. DBL should be tested with other disciplines such as engineering school, laws school, health sciences school, and should be compared with other traditional teaching and learning modes in the future. This method may support the global higher education systems to move forward the COVID-19 pandemic to set a novel standard of a future normal.

Resveratrol is a phytoalexin produced by many plants as a defense mechanism against stress-inducing conditions. The richest dietary sources of resveratrol are berries and grapes, their juices and wines. Good bioavailability of resveratrol is not reflected in its high biological activity in vivo because of resveratrol isomerization and its poor solubility in aqueous solutions. Proteins, cyclodextrins and nanomaterials have been explored as innovative delivery vehicles for resveratrol to overcome this limitation. Numerous in vitro and in vivo studies demonstrated beneficial effects of resveratrol in cardiovascular diseases (CVD). Main beneficial effects of resveratrol intake are cardioprotective, anti-hypertensive, vasodilatory, anti-diabetic, and improvement of lipid status. As resveratrol can alleviate the numerous factors associated with CVD, it has potential as a functional supplement to reduce COVID-19 illness severity in patients displaying poor prognosis due to cardio-vascular complications. Resveratrol was shown to mitigate the major pathways involved in the pathogenesis of SARS-CoV-2 including regulation of the renin-angiotensin system and expression of angiotensin-converting enzyme 2, stimulation of immune system and downregulation of pro-inflammatory cytokines release. Therefore, several studies already have anticipated potential implementation of resveratrol in COVID-19 treatment. Regular intake of resveratrol rich diet, or resveratrol-based complementary medicaments, may contribute to a healthier cardio-vascular system, prevention and control of CVD, including COVID-19 disease related complications of CVD.

Therapeutic options for the highly pathogenic human Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) causing the current pandemic Coronavirus disease (COVID-19) are urgently needed. COVID-19 is associated with viral pneumonia and acute respiratory distress syndrome causing significant morbidity and mortality. The proposed treatments for COVID-19, such as hydroxychloroquine, remdesivir and lopinavir/ritonavir, have shown little or no effect in the clinic. Additionally, bacterial and fungal pathogens contribute to the SARS-CoV-2 mediated pneumonia disease complex. The antibiotic resistance in pneumonia treatment is increasing at an alarming rate. Therefore, carbon-based nanomaterials (CBNs), such as fullerene, carbon dots, graphene, and their derivatives constitute a promising alternative due to their wide-spectrum antimicrobial activity, biocompatibility, biodegradability and capacity to induce tissue regeneration. Furthermore, the antimicrobial mode of action is mainly physical (e.g. membrane distortion), which is characterized by a low risk of antimicrobial resistance. In this review, we evaluated the literature on the antiviral activity and broad-spectrum antimicrobial properties of CBNs. CBNs had antiviral activity against 12 enveloped positive-sense single-stranded RNA viruses similar to SARS-CoV-2. CBNs with low or no toxicity to the humans are promising therapeutics against COVID-19 pneumonia complex with other viruses, bacteria and fungi, including those that are multidrug-resistant.

Shelter-in-place policies and the closure of non-essential workplaces intended to disrupt transmission of the SARS-COV-2 virus are effective approaches to combating COVID-19. They have, however, caused record levels of unemployment in the United States, raising questions of whether mitigation is more societally damaging than the disease. Here we use a coupled epidemiological-economic model to estimate the impact on employment of an unmitigated, business-as-usual approach to the pandemic. We compared unemployment between March-August 2020 in ten Californian socio-economic systems (SESs) to unemployment forecast by a model of industrial sector inter-dependencies subjected to unmitigated outbreaks of COVID-19. We found that economic losses are unavoidable because disease-driven losses propagate economically through SESs, amplifying losses to the disease. While model forecasts are generally lower than actual unemployment, jobs savings would come at the cost of greatly increased worker mortality. The costs would also be disproportionately greater among smaller and inland SESs.

The COVID-19 pandemic caused by SARS-CoV-2 has been showing a speedy growth in the number of infected patients with a remarkable mortality rate, thus it has become a worldwide public health concern. From March 8, 2020, the disease was confirmed to start spreading in Bangladesh. Since then, people got infected so exponentially that the country positions at the list of top infected countries in the world. Therefore, the objective of this comprehensive review was representing overall scenario of COVID-19 in different sectors of Bangladesh, particularly prioritizing the health sector. Up to 14 September 2020, 339,332 confirmed cases and 4,759 deaths were reported. An alarming fact is that while the global mutation rate of coronavirus is 7.23 % in average, the rate is 12.6 % in Bangladesh. Although the government ruled preventive strategies such as nationwide lockdown, social distancing, contact monitoring, quarantine and isolation, it was difficult to implement those due to lack of public awareness, inappropriate attitudes and so on. Moreover, the overburdened healthcare system had a weak response at initial stage because of insufficient healthcare facilities. Consequently, this pandemic affected severely almost all the important sectors of the country, specifically the economy, agriculture and health sectors. Hence, focusing on healthcare system as well as maintaining social distance and other essential precautions can limit the spread of infection and help to alleviate the severity of the pandemic.

During the COVID-19 pandemic face masks grew in importance as their use by the general population was recommended by health officials in order to minimize the risk of infection and prevent further spread of the virus. To ensure health protection of medical personal and other system relevant staff, it is of considerable interest to quickly test if a certain lot of filtering facepiece masks meets the requirements or if the permeability changes under different conditions. As certified penetrometers are rather expensive and were difficult to obtain during the COVID-19 pandemic, we describe two quite simple and cheap methods to quickly test the filter permeability based on an electronic cigarette. The first method uses a precision scale, the second method uses a light scattering detector to measure the filter penetration. To make sure these two methods yield reliable results, both were tested with freshly cut filter samples covering the range of approx. 7% to 60% permeability and compared to the results of a certified penetrometer. The comparison of the two methods with the certified penetrometer showed a good correlation and therefore allow a quick and rather reliable estimation of the permeability. Several examples about the use of faulty masks and the resulting health risks show that simple, fast, cheap and broadly available methods for filter characterization might be useful in these days.

The new coronavirus disease 2019 (COVID-19) pandemic is an emerging situation with high rates of morbidity and mortality, in the pathophysiology of which inflammation and thrombosis are implicated. The disease is directly connected to the nutritional status of patients and a well-balanced diet is recommended by official sources. Recently, the role of platelet activating factor (PAF) was suggested in the pathogenesis of COVID-19. In the present review several micronutrients (vitamin A, vitamin C, vitamin E, vitamin D, selenium, omega-3 fatty acids, minerals), phytonutrients and Mediterranean diet compounds (olive oil, fish, honey, plant foods) with potential anti-COVID activity are presented. We further underline that the well-known anti-inflammatory and anti-thrombotic actions of the investigated nutrients and/ or holistic dietary schemes, such as the Mediterranean diet, are also mediated through PAF. In conclusion, although there is no single food to prevent coronavirus, the aim is to follow a healthy diet containing PAF inhibitors in order to target both inflammation and thrombosis and try to avoid or/and reduce the deleterious effects of the COVID-19 epidemic.

This paper establishes a prognosis of the long term environmental impact of various car subsidy concepts. The CO2 emissions of the German car fleet impacted by the purchase subsidies are determined. A balance model of the CO2 emissions of the whole car life cycle is developed. Consideration of production-, use- and End-of-Life processes are taken into account. The implementation of different subsidy scenarios directly affects the forecasted composition of the vehicle population and therefore the resulting life cycle assessment. All scenarios compensate the additional emissions required by the production pull-in within the considered period and hence reduce the accumulated CO2 emissions until 2030. The exclusive funding of BEVs is most effective with a break-even in 2025.

The coronavirus (COVID-19) pandemic was particularly invasive in Italy during the period between March and late April 2020 then decreased in both in the number of infections and in the seriousness of the illness throughout the summer of 2020. In this discussion, we measure the severity of the disease by the ratio of Intensive Care Units (ICU) spaces occupied by COVID-19 patients and the number of Active Cases (AC) each month from April to October 2020. We also use the ratio of the number of Deaths (D) to the number of Active Cases. What clearly emerges, from rigorous statistical analysis, is a progressive decrease in both ratios until August, indicating progressive mitigation of the disease. This is particularly evident when comparing March-April with July-August; during the summer period the two ratios became roughly 18 times lower. We test such sharp decreases against possible bias in counting active cases and we confirm their statistical significance. We then interpret such evidence in terms of the well-known seasonality of the human immune system and the virus-inactivating effect of stronger UV rays in the summer. Both ratios, however, increased again in October as ICU/AC began to increase in September 2020. These ratios and the exponential growth of infections in October indicate that the virus - if not contained by strict measures - will lead to unsustainable challenges for the Italian health system in the winter of 2020-2021 .

(1) Background: A global pandemic due to COVID-19 emerged in November 2019 and hit France in early March 2020. It not only resulted in a loss of lives but also in very strict confinement measures. The objective of this study was to understand what the determinants of the change in participants’ behavior and mental state were during the confinement. (2) Methods: An online survey was launched on April 23rd, 2020, and closed on May 7th, 2020. The final sample included 1454 participants from 24 to 65 years old. Descriptive and multivariate analyses were then performed. (3) Results: 28.7% reported having a more balanced diet, against 17.1% with a less balanced diet. 22.7% of respondents reported an increased alcohol consumption, as opposed to only 12.2% declaring a decrease and 11.2% of respondents increased their tobacco consumption, while 6.3% decreased it. 50.6% of the participants reported being more depressed, stressed, or irritable since the beginning of the lockdown. Confinement had a negative effect on every behavior studied in this survey, except for nutrition. We also found that negative mental state changes were strongly associated with nutrition, sleep, physical activity, and alcohol consumption changes.

Pediatric inflammatory multisystem syndrome (PIMS) is a new entity in children, likely associated with previous coronavirus disease 19 (COVID-19). Most of reports about PIMS come from countries particularly hit by the COVID-19 pandemic. Our aim was to investigate the nature of inflammatory syndromes in Poland (a country with low COVID-19 prevalence) and to perceive the emergence of PIMS in our country. On May 25th, we have launched a nationwide survey of inflammatory syndromes in children for retrospective (since 4th March 2020) and prospective data collection. Up to 28th July, 39 reported children met inclusion criteria. We stratified them according to age (&lt;5 and ≥ 5 years old) and COVID-19 status. The majority of children had clinical and laboratory features of Kawasaki disease, probably non-associated with COVID-19. However, children ≥5 years of age had PIMS characteristics, and 9 children had COVID-19 confirmation. This is the first to our knowledge report of PIMS register from the country with low COVID-19 prevalence, and it proves that PIMS may emerge in any area involved in the COVID-19 pandemic. In a context of limited COVID-19 testing availability, other risk factors of PIMS, e.g. older age should be considered in the differential diagnosis of inflammatory syndromes in children.

COVID-19, previously known as “2019 novel coronavirus”, is a newly discovered virus which causes severe acute respiratory syndrome, similar to corona virus 2 (SARS-CoV-2), which has spread widely through human to human contact and was declared a pandemic by the WHO in March 2020. To cope with this pandemic many countries have adopted nationwide lockdowns which restrict nonessential activities and encourage their populations to avoid public transport, work from hone wherever possible, and to maintain social distancing at all times. While the severity of these shutdowns has varied with country, large geographic regions of the world (including China, India, Iran, Italy, Spain, and the USA) have all been severely affected, not just in the loss of human life, but also in terms of the financial impacts the lockdowns will have on their countries future prosperityIt was previously reported that a number of environmental factors, including humidity and temperature, played an important role in development and spread of the SARS-Corona Virus infection with the virus retaining viability for over 5 days at temperatures between 22–25^oC and relative humidity (RH) of 40–50%. Whereas, elevated temperatures and higher RH (38^oC, and >95% RH) decreased virus viability (Kroumpouzos et al., 2020). The spread of COVID-19 started in low temperature areas of China, with major outbreaks subsequently occurring in Iran, Japan, Northern Italy and South Korea. These new virus epicenters all had similar temperature and latitude, along the 30-50^◦N” zone. Subsequently, the virus was spread to regions of elevated temperature, such as India, the Middle East and Thailand, due to international travel (Kroumpouzos et al., 2020).The aim of this study was to consider the environmental impact of COVID-19, including water pollution. The paper is divided into four sections. In the first section the current literature related to COVID-19 is reviewed. In the second section a recent update on COVID-19 globally is presented, followed by a descriptive impact on the environment in the third section and finally in the fourth section the COVID-19 related worldwide environmental impact is discussed. Since COVID-19 is a currently an active pandemic with no end in sight, while constructive conclusions can only be made on the limited data currently, which may be prone to high errors. However, these conclusions may provide some preliminary suggestions for assisting in assessing spreading patterns of COVID-19 across the globe, and may be of long-term significances with respect to assessing the environmental impact of lockdown policies due to COVID-19 worldwide.

The COVID-19 pandemic continues to ravage the world, with the United States being highly affected. A vaccine provides the best hope for a permanent solution to controlling the pandemic. However, to be effective, a vaccine must be accepted and used by a large majority of the population. Structural equation modelling was used to analyze the relationships of several factors with attitudes toward potential COVID-19 vaccination. The survey was administered to 316 respondents across the United States by a survey corporation. Prior vaccine usage and attitudes predicted attitudes towards COVID-19 vaccination. Assessment of the severity of COVID-19 for the United States was also predictive. Approximately 68% of all respondents were supportive of being vaccinated for COVID-19, but side effects, efficacy, and length of testing remained concerns. Longer testing, increased efficacy and development in the United States were significantly associated with increased vaccine acceptance. Messages promoting COVID-19 vaccination should seek to alleviate the concerns of those who are already vaccine-hesitant. Messaging directed at the benefits of vaccination for the United States as a country would address the second predictive factor. Enough time should be taken to allay concerns about both short and long-term side effects before a vaccine is released.

Policy induced decline of human mobility has been recognised to be effective in controlling the COVID-19 spread especially in the initial stage of the outbreak, although the relationship among mobility, policy implementation, and virus spread remains contentious. Coupling data of confirmed COVID-19 cases with Google mobility data in Australia, we present a state-level empirical study to: 1) inspect the temporal variation of COVID-19 spread and the change of mobility adherent to social restriction policies; 2) examine the extent that different types of mobility are associated with the COVID-19 spread in eight Australian states/territories; and 3) analyse the time-lag effect of mobility restriction on the COVID-19 spread. We find that social restriction policies implemented in the early stage of the pandemic controlled the COVID-19 spread effectively; the restriction of human mobility has a time-lag effect on growth rates, and the strength of the mobility-spread correlation increases up to seven days after policy implementation but decreases afterwards. The association between mobility and COVID-19 spread varies across space and time, and subjects to the types of mobility. Thus, it is important for governments to consider the degree to which lockdown conditions can be eased by accounting for this dynamic mobility-spread relationship.

Geoscientists developed geoethics, an intra-disciplinary field of applied philosophical studies, during the last decade. Reaching beyond the sphere of professional geosciences, it led to professional, cultural, and philosophical approaches to handle the social-ecological structures of our planet ‘wherever human activities interact with the Earth system’. Against the backdrop of the COVID-19 and considering geoscientists’ experiences dealing with disasters (related to hazards like tsunamis, floods, climate changes.), this essay (1) explores the geoethical approach, (2) re-casts geoethics within western philosophical systems, such as the Kantian imperatives, Kohlberg scale of moral adequacy, Jonas’ imperative of responsibility, and (3) advances a ‘geoethical thesis’. The latter takes the form of a hypothesis of a much broader scope of geoethics than initially envisioned. That hypothesis appears by suspecting a relationship between the relative successes in the COVID-19 battle with the positioning of agents (individual, collective, institutional) into ethical frameworks. The turmoil caused by the COVID-19 pandemic, calls for the transfer of experiences between different disciplinary domains to further sustainable governance, hence generalising the geoethical approach. It is emphasized that only when behaving as responsible and knowledgeable citizens, then people of any trade (including [geo-]scientists) can transgress the boundaries of ordinary governance practices with legitimacy.

Coronavirus disease 2019 (COVID-19) is associated with high risk of malnutrition, primarily in elderly people; assessing nutritional risk using appropriate screening tools is critical. This systematic review identified applicable tools and assessed their measurement properties. Literature was searched in the MEDLINE, Embase, and LILACS databases. Four studies conducted in China met the eligibility criteria. Sample sizes ranged from six to 182, and participants’ ages from 65 to 87 years. Seven nutritional screening and assessment tools were used: the Nutritional Risk Screening 2002 (NRS-2002), Mini Nutritional Assessment (MNA), MNA-short form (MNA-sf), Malnutrition Universal Screening Tool (MUST), Nutritional Risk Index (NRI), Geriatric NRI (GNRI), and modified Nutrition Risk in the Critically ill (mNUTRIC) score. Nutritional risk was identified in 27.5% to 100% of participants. The NRS-2002, MNA, MNA-sf, NRI, and MUST demonstrated high sensitivity; the MUST had better specificity. The MNA and MUST demonstrated better criterion validity. The MNA-sf demonstrated better predictive validity for poor appetite and weight loss; the NRS-2002 demonstrated better predictive validity for prolonged hospitalization. mNUTRIC score demonstrated good predictive validity for hospital mortality. Most instruments demonstrate high sensitivity for identifying nutritional risk, but none are acknowledged as the best for nutritional screening in elderly COVID-19 patients.

The 2020 Tokyo Olympics has been postponed due to the novel coronavirus (COVID-19) pandemic. The implications for industries related to the Olympics—tourism, hotels and restaurants, and others—are expected to be affected by reduced demand. Japanese workers in these industries were prepared to offer their hospitality to visitors from around the world. They would be satisfied from not only an increase in income but also in offering visitors a taste of Tokyo’s great hospitality if the Olympics had been held in 2020. However, postponement of the sporting event is likely to have a significant impact on their happiness level. We independently collected individual-level panel data from March to April 2020. Based on this, we found that the happiness level of workers in the tourism and restaurant sectors declined drastically after the announcement of the postponement. Only two weeks later, their happiness level did not alter from the pre-announcement level. This tendency was strongly observed in Tokyo and the surrounding prefectures, but not in other prefectures. However, workers engaged in the tourism and restaurant sectors did not predict a decrease in their income even after the postponement. Combined, these findings indicate that loss of extending hospitality, rather than reduction in income, temporarily reduces the happiness level of workers.

COVID-19 pandemic represents an unprecedented sanitary threat: antiviral and host-directed medications to treat the disease are still urgently needed.A great effort has been paid to find drugs and treatments for hospitalized, severely ill patients. However, medications used for the domiciliary management of initial symptoms, notwithstanding their importance, have not been and are not presently regarded with the same attention. In analogy with other respiratory viral infections, COVID-19 patients in the early phase require specific antivirals (still lacking) and non-etiotropic drugs to lower pain, fever and control inflammation. Non-steroidal antinflammatory drugs (NSAIDs) and paracetamol (PAC) are widely used as non-etiotropic agents in these conditions and hence are both theoretically repurposable for COVID-19. However, a warning from some research reports and National Authorities raised NSAIDs safety concerns because of the supposed induction of ACE2 protein levels (the receptor used by SARS-CoV2 to enter host airways cells), the risk of bacterial superinfections and masking of disease symptoms. As a consequence, the use of NSAIDs was, and is, strongly discouraged while the alternative adoption of paracetamol is still preferred.On the basis of novel data and hypothesis on the possible role of scarce glutathione (GSH) levels in the exacerbation of COVID-19 and of the GSH depleting activity of PAC, this commentary raises the question of whether PAC may produce an oxidative imbalance which could be detrimental in COVID-19 clinical outcomes.

Despite great advances in understanding the dynamics of viral epidemics, the emergence of rapidly spreading, highly pathogenic viruses remains a realistic and catastrophic possibility, which current health systems may not be able to fully contain. An intriguing feature in many recent zoonotic viral outbreaks is the presence of superspreaders, which are infected individuals that cause dramatically more new cases than the average. Here I study the effect of superspreaders on the early dynamics of emerging viruses that have not gained the capacity for efficient human-to-human transmission, i.e viruses with R0 < 1. I show that superspreaders have a higher chance of rapid extinction, but under crowded conditions can lead to outbreaks, causing far more cases than regular viruses. I suggest that outbreaks of highly pathogenic superspreaders are more likely when they coincide in time and space with an unrelated outbreak leading to increased hospital admission rates. These superspreader outbreaks may be difficult to detect, especially in the context of a different epidemic in progress, and can significantly affect mortality patterns observed in affected areas.

Coronavirus disease is the current cause of global concern. The massive outbreak of COVID-19 has led the World Health Organization (WHO) to declare this as a pandemic situation. The Severe Acute Respiratory Syndrome Coronavirus-2 (SARSCoV-2) is responsible for COVID-19 leading to acute respiratory distress and substantial mortality in humans. However, the first laboratory confirmation of SARS-CoV-2 in a pet dog in Hong Kong has shown the possibility of human-to-animal transmission (zooanthroponotic) of the virus. Thereafter, many animals including cat, tiger, lion and mink have also been reported to acquire the virus in several countries. In this situation the role of veterinarian assumes important in treating the animals, helping in food security, disease diagnosis, surveillance and boosting the economy of livestock stakeholders at the grassroot level. In the absence of any selective vaccine or drug against SARS-CoV-2, the world is anticipated to triumph over this pandemic with collaborative, multisectoral, and transdisciplinary approach linking human, animal and environmental health. This article gives an insight into the confirmed SARS-CoV-2 outbreaks in animals, including the factors behind the shuffling of the virus among variety of species and also emphasizes on the role of veterinarian in managing and safeguarding public health so as to pave the way for adopting one health approach in order to conserve biodiversity.

Nigeria is the most populous country in the African continent. The aim of this study was to analyze risk factors for COVID-19 prevalence and deaths in all 6 geopolitical regions and 37 states in Nigeria. We analyzed the data retrieved from various sources, including Nigeria CDC, Nigeria National Bureau of Statistics, Unicef-Nigeria multiple indicator cluster survey and the Institute of Health Metrics and Evaluation, University of Washington. We examined 4 clinical risk factors (prevalence of TB, HIV, smoking and BCG vaccination coverage) and 5 sociodemographic factors (age ≥65, population density, literacy rate, unemployment and GDP per capita). Multivariate modeling was conducted using generalized linear model. Our analysis showed that the incidence of confirmed COVID-19 cases differed widely across the 37 states, from 0.09 per 100,000 in Kogi to 83.7 in Lagos. However, more than 70% of confirmed cases were concentrated in just 7 states: Lagos, Abuja, Oyo, Kano, Edo, Rivers and Delta. Case mortality rate (CMR) per million population also varied considerably, with Lagos, Abuja and Edo having CMR above 9. On bivariate analysis, higher CMR correlated positively with GDP and to a lesser extent with TB and population density. On multivariate analysis, which is more definitive, states with higher HIV prevalence and BCG coverage had lower CMR, while high GDP states had a greater CMR. This study indicates that COVID-19 has disproportionately affected certain states in Nigeria. Population susceptibility factors include higher economic development but not literacy or unemployment. Death rates were mildly lower in states with higher HIV prevalence and BCG vaccination coverage.

The Coronavirus Disease 2019 (COVID-19) pandemic has resulted in a significant surge of critically ill patients and an unprecedented demand on intensive care services. The rapidly evolving understanding of pathogenesis, limited disease specific evidence and demand-resource imbalances have posed significant challenges for intensive care clinicians. COVID-19 is a complex multisystem inflammatory vasculopathy with a significant mortality implication for those admitted to intensive care. Institutional strategic preparation and meticulous intensive care support are essential to maximising outcomes during the pandemic. The significant mortality variation observed between institutions and internationally, despite a single aetiology and uniform presentation, highlights the potential influence of management strategies on outcome. Given that optimal organ support and adjunctive therapies for COVID-19 have not yet been well defined by trial-based outcomes, strategies are predicated on existing literature and experiential learning. This review outlines the relevant pathophysiology and management strategies for critically ill patients with COVID-19, and shares some of the collective learning accumulated in a high volume Severe Respiratory Failure centre in London.

Contact tracing has become an indispensable tool of various extensive measures to control the spread of COVID-19 pandemic due to novel coronavirus. This essential tool helps to identify, isolate and quarantine the contacted persons of a COVID-19 patient. However, the existing contact tracing applications developed by various countries, health organizations to trace down the contacts after identifying a COVID-19 patient suffers from several security and privacy concerns. In this work, we have identified those security and privacy issues of several leading contact tracing applications and proposed a blockchain-based framework to overcome the major security and privacy challenges imposed by the applications. We have discussed the security and privacy measures that are achieved by the proposed framework to show the effectiveness against the security and privacy issues raised by the existing mobile contact tracing applications.