Background: Accurate estimation of the spread of SARS-CoV-2 is crucial for guiding public health strategies. Underreporting from PCR-based testing, especially in low- and middle-income countries, often obscures the true extent of exposure and immunity to coronavirus disease 2019 (COVID-19). This study aimed to determine the seroprevalence and antibody levels against SARS-CoV-2 among patients visiting hospital-based sentinel sites in Kenya's Rift Valley region following the Omicron wave. Method: We conducted a cross-sectional study in four hospital-based sentinel sites among patients with acute respiratory infection symptoms. Patients aged six months or older visiting the sites between January 2022 and December 2022, presenting with symptoms of acute respiratory infection, were enrolled. Clinical and sociodemographic data were collected using a structured questionnaire. We used a quantitative ELISA kit to detect IgG antibodies against SARS-CoV-2 S protein in serum samples. Results: Among 557 individuals enrolled in the study, the seroprevalence of SARS-CoV-2 antibodies was 97.8% (n=545). Vaccinated individuals demonstrated significantly higher odds of seropositivity compared to unvaccinated counterparts, with an odds ratio of 3.33 (95% CI: (0.4, 27.87)). While seropositivity remained consistent across age groups, older adults exhibited the highest odds. Site-specific differences in enrolment and vaccination rates highlight potential access-related disparities. Conclusion: Our findings indicate widespread prior exposure to SARS-CoV-2 within the study region, underscoring the significant impact of both natural infection and vaccination efforts in driving SARS-CoV-2 seroprevalence within the Rift Valley region. Despite the underestimation of infections and disparities in vaccination access, this study demonstrates the effectiveness of vaccination for conferring SARS-CoV-2 immunity. Targeted interventions are crucial to address accessibility barriers and vaccine hesitancy, ensuring equitable vaccination coverage.

ABSTRACT Background: To date, the COVID-19 pandemic has been the foremost health concern for humankind in the new millennia. This paper aims to describe the related hospitalizations in Italy during the first two years of the health emergency. Design and methods: This is a retrospective, population-based study of Italian hospitalizations for patients diagnosed with COVID-19 during the 2020-2021 period, extracted from the National Hospital Discharge Registry. The outcome variables considered include hospital admissions, costs, and length of stay, among other hospitalization-level variables. Costs were estimated through the charges associated with the Diagnosis-Related Group and Major Diagnostic Categories coding system, plus an additional cost attributed to COVID-19 admissions. To these charges was added an extra cost defined by the ministry of health. Results: In Italy, there were 357,354 hospitalizations for COVID-19 attributed to 298,856 patients in 2020 and 399,043 hospitalizations for COVID-19 attributed to 333,447 patients in 2021. COVID-19 patients faced a transfer rate thrice that of other patients. Hospitalizations were concentrated predominantly in the northern regions, particularly in the first year. Hospitalization rates varied by age in a sine wave pattern, peaking in the youngest and oldest age groups, with mortality rates escalating with age— tending to remain below 3% for those under 44 but surging to 40% in individuals over 75. The financial impact of COVID-19 hospitalizations was substantial, with total costs reaching €3.97 billion in 2020 and €4.99 billion in 2021. Costs per admission and per day also rose, from €11,112 and €807 in 2020 to €12,503 and €844 in 2021, respectively. Excluding the added financial burden of COVID-19, costs would have been notably lower. Hospitalizations involving continuous invasive mechanical ventilation were particularly costly (about 24.000 euros x admission), reflecting the significant resources required for these treatments. Conclusion: Implementing a protective pad around the entire health system that leverages networks of family doctors and nurses, connected in real time to the entire health system, can be crucial. Such a network, tasked with monitoring the local epidemiological situation, protecting vulnerable individuals also through telehealth visits, and establishing a triage system for infections in the initial phase, may effectively help in managing virus spread and protecting hospitals from unpredictable waves of admission demand. Strengthening primary health care could be a decisive factor for the future and enhance the system's resilience in facing new challenges.

The purpose of this study is to examine the match-related performance (scores and penalties) of the athletes in the Junior EJC (European Judo Championship) and U23 EJC categories before and immediately after the Covid-19 quarantine, according to gender and weight category groups. Our sample was based on the junior and U23, male and females, 2019-2020 Junior European Judo Championships and 2019-2020 U23 European Judo Championships. A total of 1431 matches in these tournaments were analyzed: male (n=812) and female (n=619). The main findings of this study showed that most matches in both the male and female categories resulted in ippon (2019-2020 average: 64,35% for Junior male, 70,55% for U23 male and 69,3% for Junior female, 64,4% for U23 female). No significant differences (p > 0.05) were observed between gender and age groups concerning the match scores. In the formation phase of the technique, considerations of high- and low-intensity actions, and analysis of the speed of athletes during matches in official competitions can help to better understand the dynamics of the variability of movements in judo matches. In addition, suggestions are presented to be applied to athletes in different age categories who are on the way to become Olympic athletes.

Nurses have experienced several psychological and work-related issues during the COVID-19 pandemic including pandemic burnout and job burnout. The aim of the study was to examine the impact of social support and resilience on COVID-19 pandemic burnout and job burnout among nurses. We conducted a cross-sectional study in Greece. Study population included 963 nurses. We measured social support, resilience, COVID-19 pandemic burnout, and job burnout with the Multidimensional Scale of Perceived Social Support, Brief Resilience Scale, COVID-19 burnout scale, and single item burnout measure respectively. Nurses received high levels of social support, while their resilience was moderate. Additionally, nurses experienced moderate levels of COVID-19 burnout and job burnout. Increased social support (adjusted beta = -0.075, 95% CI = -0.125 to -0.024) and increased resilience (adjusted beta = -0.399, 95% CI = -0.491 to -0.308) were associated with reduced COVID-19 pandemic burnout. We found a negative relationship between social support and job burnout (adjusted beta = -0.263, 95% CI = -0.405 to -0.121). A similar negative relationship was found between resilience and job burnout (adjusted beta = -0.529, 95% CI = -0.785 to -0.272). Social support and resilience can act as protective factors against COVID-19 pandemic burnout and job burnout among nurses. Policy makers should develop and implement appropriate strategies to improve nurses’ social support and resilience since they are the backbone of healthcare systems worldwide.

Purpose: This study analysed the impact of the COVID-19 pandemic on the diagnosis of malignant neoplasia of the bronchus and lung. Cases diagnosed in the Burgos region in the year prior to the official declaration of the pandemic were compared with those in the year after the pandemic. The research sought to identify whether there was a decrease in the number of cases during the pandemic, and whether this may have led to a delay in diagnosis, reflected in more advanced stages of the disease. Mortality and survival time in each of the periods were also analysed.

Aims: The study aims to take the COVID-19 pandemic as an example to provide a scientific reference for diabetic patients’ self-health management and nurses’ work for these patients when facing future pandemics. Review Methods: It conducted a comprehensive literature search and analysed relevant texts. This article reviews the daily health management of diabetic patients in the context of the COVID-19 pandemic and the role that nurses should play in this process. Results: Diabetic patients face challenges in self-health management during the pandemic, including disruptions in healthcare access, increased mental problems, and unhealthy lifestyles. Nurses serve as the front-line interface between these patients and the healthcare system. Adopting telehealth and remote consultation has effectively bridged the gap created by social distancing measures. Conclusion: Daily self-health management can significantly improve glycemic control and reduce the risk of diabetes-related complications, which is vital during the pandemic when patients may be experiencing disruptions to their routine care. Moreover, empowering patients through educational initiatives led by nurses can bring better self-monitoring, medication adherence, and lifestyle modifications, all of which are crucial in mitigating the effects of diabetes on the body’s immune response, thus reducing the severity of COVID-19 if contracted.

The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) infection has required a complete change in the management of patients with gastrointestinal disease who needed to undergo endoscopic procedures. In the second year of the COVID-19 pandemic, due to restrictions for elective endoscopic procedures a large number of cancer patients were prevented from early diagnosis of several digestive cancers, which has led to a serious burden in the health system which nowadays needs to be dealt with. We designed a prospective study that included patients in whom access to elective endoscopic examinations during the COVID-19 pandemic has been delayed. Our aim was to investigate the impact of the COVID-19 pandemic on the diagnosis rate of digestive tract malignancies in the context of a health crisis management that generates an ethical dilemma regarding the balance of utilitarianism versus deontology. Our study shows that the decrease in the number of newly diagnosed gastrointestinal cancers by endoscopy and biopsy during the pandemic restrictions and the delay in diagnosis have hads a clear impact on stage migration due to disease progression.

Introduction: The viral respiratory disorder known as severe acute respiratory syndrome (SARS) is caused by the SARS-associated coronavirus. End of May 2021, there have been over 170 million reported cases and more than 3.53 million deaths worldwide. In the field of cardiovascular performance, the shock index (SI) is a simple and widely used formula that measures the physiological response prior to systemic hypotension. It is obtained by dividing the heart rate by the systolic blood pressure. Another parameter, the modified shock index (MSI), is defined as the ratio of heart rate to mean arterial pressure (MAP). Methods: In this retrospective study, we examined the data of COVID-19 patients who were admitted to the ICU between June 1st, 2020, and January 31st, 2021. The patient details were collected from the Medical Records Department (MRD) in a tertiary care center. A case-recorded proforma was used to record the patient information, which was then analyzed using SPSS software. Results: The mean age of the patients was 67 years, consisting of 64 males (68.9%) and 29 females (31.1%). The standard deviation was calculated as 13.557. Among the patients, the minimum age recorded was 28, while the maximum age was 97. Patients with known CAD (Coronary Artery Disease) had a higher mortality rate among comorbidities. The p-value for Shock Index and Mortality Status was 0.205 (with an alpha value greater than 0.05), indicating no significant association. However, the modified shock index (MSI) showed a significant association with mortality status. The Pearson chi-square value for MSI and Mortality Status was 4.19, with a p-value of 0.041 (with an alpha value less than 0.05). These results suggest that there is a higher risk of mortality for patients with a Modified Shock Index of less than 0.7 or greater than 1.3. The MSI Odds ratio was found to be 4.500, indicating that such patients have a 4.5 times higher risk of mortality compared to others. Conclusion: In conclusion, our study found that there is no significant association between the Shock Index (SI) and mortality, as the p-value was greater than 0.05. However, the Modified Shock Index (MSI) showed a significant association with mortality status, with a p-value less than 0.05. This suggests that patients with a Modified Shock Index less than 0.7 or greater than 1.3 are at a higher risk of mortality. It is important to consider these findings when assessing the prognosis and potential interventions for COVID-19 patients.

Despite the crucial role the COVID-19 vaccine played in curbing the pandemic, a significant portion of Black and African American individuals expressed hesitancy in being vaccinated. This review aimed to identify the determinants of COVID-19 vaccine hesitancy among Black and African American individuals in the USA. The literature search was conducted in December 2022 according to the PRISMA criteria focusing on empirical studies. Data extraction methods, critical appraisal, and secondary thematic analysis were conducted on both quantitative and qualitative studies. Sixteen quantitative studies identified key factors associated with vaccine hesitancy such as confidence in vaccine effectiveness, safety, and trust in the healthcare system. 14 qualitative studies revealed major themes of mistrust, fear, and information needs, including historical mistrust, concerns about the vaccine development process, and contemporary institutional mistrust. The synthesis of quantitative and qualitative findings derived from this review provides a nuanced understanding of determinants of vaccine hesitancy in Black and African American communities in the USA, offering a foundation for the development of evidence-based interventions. Mistrust in the healthcare system, fear, and informational gaps on vaccine safety and effectiveness have been identified as significant barriers to vaccination, demanding targeted interventions.

We assessed the association between cirrhosis and severe COVID-19-related outcomes among people with laboratory-diagnosed COVID-19 infection in British Columbia, Canada. We used data from the British Columbia (BC) COVID-19 Cohort, a population-based cohort that integrates data on all individuals tested for COVID-19 with data on hospitalizations, medical visits, emergency room visits, prescription drugs, chronic conditions, and deaths in the Canadian province of BC. We included all individuals, aged ≥ 18 who tested positive for SARS-CoV-2 by real-time reverse transcription-polymerase chain reaction, from January 01, 2021, to December 31, 2021. Multivariable logistic regression models were used to assess the associations between cirrhosis status and COVID-19-related hospitalization and ICU admission. Of the 162,509 individuals who tested positive for SARS-CoV-2 and were included in the analysis, 768 (0.5%) had cirrhosis. In the multivariable models, cirrhosis was associated with increased odds of hospitalization (aOR=1.97, 95% CI: 1.58 – 2.47) and ICU admission (aOR=3.33, 95% CI: 2.56 – 4.35). In the analyses stratified by age, we found that the increased odds of ICU admission among people with cirrhosis were present in all the assessed age-groups. Cirrhosis is associated with increased odds of hospitalization and ICU admission among COVID-19 patients.

The aim of this study was to analyze the profile of IgG subclasses in COVID-19 convalescent Puerto Rican subjects and compare this profile with those exhibited by no-infected immunocompetent or immunocompromised subjects that received the mRNA vaccine. The most notable find-ngs from this study are: 1) Convalescent subjects that were not hospitalized developed high and long-lasting antibody response. 2) Both, IgG1 and IgG3 are the subclasses more prevalent in the SARS-CoV-2 infected population whereas IgG1 is more prevalent after vaccination. 3) Individuals that first had the infection and further received two doses of mRNA vaccines exhibited more robust neutralizing capacity against Omicron than those that were never infected and received two doses of Pfizer-BioNTech vaccine. 4) A class switch toward the “anti-inflammatory” anti-body isotype IgG4 is induced a few weeks after the third dose, which peaked abruptly and remained at high levels for a long period. Moreover, the high levels of IgG4 are concurrent with high neutralizing percentages against various VOC including Omicron. 5) Subjects with IBD also develop IgG4 after the third dose, although these antibody levels have limited effect on the neutralizing capacity. Knowing that the mRNA vaccines do not prevent reinfections, all Omicron sub-variants that are dominant worldwide have shown to be less pathogenic, and the IgG4 levels have been associated to immunotolerance and causative of numerous negative effects, the recommendations of successive administration of booster vaccinations to people should be revised.

The rapid emergence of COVID-19 necessitated policy responses worldwide, focusing on vaccination and mobility restrictions. However, studies on individual non-pharmacological preventive measures are less common. In particular, Chile represents a unique scenario for analyzing the adoption of preventive measures and changes amid aggressive communication and vaccination campaigns. This study aims to provide insights into public adherence to non-pharmacological measures in the face of diseases, using a cohort of 386 participants from 2021 to 2022. This was achieved by employing a questionnaire to measure adherence to self-care practices and by analyzing contact tracing data from health authorities. We performed bivariate analysis and a linear regression model. Mask-wearing in public places was the most commonly used measure (95.9% in 2021 and 89.9% in 2022). The median adherence score increased from 18 to 19 for both measurements, respectively. The regression model shows that women are more likely to adopt preventive behaviors in both waves and being a young adult (30-49 years) predicted the adoption of behavioral precautions in 2022. Adherence to preventive measures increased even with high vaccination coverage, likely due to the epidemiological situation with the Omicron variant circulating in 2022.

The COVID-19 pandemic has raised concerns about its impact on maternal and neonatal health. This study aimed to investigate the influence of maternal COVID-19 infection during pregnancy on neonatal inflammatory parameters. A retrospective cohort study was conducted at Premiere Hospital in Timisoara between May 2021 and January 2022. Participants were categorized into two groups: the COVID-19 positive group, consisting of patients with confirmed SARS-CoV-2 in-fection during pregnancy, and the control group, which comprised COVID-19-free pregnant women. The primary outcome was the assessment of inflammatory markers (NLR, dNLR, PLR, and SII) in neonates born to mothers with COVID-19. The results suggest that maternal COVID-19 infection during pregnancy significantly impacts certain neonatal inflammatory parameters. Spe-cifically, newborns exposed to maternal COVID-19 exhibited elevated white blood cell counts, particularly when infection occurred during the first trimester. Lymphocyte counts were dimin-ished in neonates born to COVID-19-positive mothers, irrespective of infection trimester. Gesta-tional age played a role in altering neonatal immune profiles, with correlations observed between GA and parameters in the Control Group (COVID-19 negative during pregnancy). However, the influence of neonatal immunoreactivity on laboratory parameters remained generally non-significant after adjusting for GA and infection trimester. In conclusion, maternal COVID-19 infection during pregnancy has a discernible impact on neonatal inflammatory parameters, in-cluding WBC and lymphocyte counts, which may have clinical implications.

The teaching and learning environment have changed significantly over the last decade with the integration of an increasing amount of information and communication technologies, especially in distance education due to global pandemics, total lockdowns, isolation, and quarantine periods. The number of numerous virtual and non-virtual tools involved in educational processes is growing day by day. In terms of technological innovations used in learning environments, many researchers and educators are trying their best to bring more creative ideas into the technology- based learning environments. Although higher educational institutions have greatly benefited from the growing number of hardware and software resources in the educational process, they have also faced some setbacks that have harmed the learning processes. These technologies have in turn complicated some of the processes in the learning atmosphere. Therefore, we take Spanish teaching course as an example to present the challenging smarter teaching and learning systems that higher educational institutions face today.

(1) Background: Various cutaneous adverse drug reactions (ADRs) are observed with the development of mRNA COVID-19 vaccines. To gain insight into the clinicopathologic features, we analyzed the correlation of histological and clinical data in 48 patients with these ADRs.; (2) Methods: Single-center retrospective study in patients with ADRs post-mRNA COVID-19 vaccination (mRNA-1273 and BNT162b2 vaccines).; (3) Results: Distant generalized ADRs prevailed (91%), often appearing clinically as spongiotic dermatitis or maculo-papular exanthema. Histopathological analysis revealed spongiotic changes (46%) and dermal superficial perivascular lympho-histiocytic infiltrates (17%). Eosinophils were found in 66% of biopsies, neutrophils in 29%, and plasma cells only in 8% of biopsies. Most ADRs occurred post-second vaccine dose (44%). Histologically spongiotic changes were associated with clinical features of spongiotic dermatitis in only 50% and maculo-papular exanthema in the remaining patients. ADRs represented an aggravation of preexisting skin disease in 23% of patients. ADRs regressed within 28 days or less in 53% of patients and persisted beyond a month in the remaining patients.; (4) Conclusions: Our study demonstrates a diverse spectrum of generalized ADRs, revealing correlations between histology and clinical features but also instances of divergence. The majority of ADRs are self-limited with a few extending beyond a month.

his quantitative study investigates teachers' perceptions of self-efficacy during the COVID-19 pandemic and explores the correlation between these perceptions and the preservice training they received. The research addresses the cognitive connection between teachers' current self-efficacy, particularly their satisfaction with and appreciation of preservice lecturers. Utilizing a retrospective lens, the study reveals a significant correlation between teachers' evaluation of their preservice training, especially their appreciation of lecturers, and their present self-efficacy. The findings highlight that teachers, amidst the challenges of the pandemic, evaluated their self-efficacy at a remarkably high level. This underscores their resilience during a period of unprecedented uncertainty, demanding substantial personal and professional adaptability. The nuanced interplay observed suggests that teachers' sense of self-efficacy serves as a predictive variable of their mental and professional resilience when confronting uncertainty and navigating rapid and profound changes, as exemplified by the exigencies of the COVID-19 pandemic.

The SARS-CoV-2 have caused a devastating pandemic of all times in the recent human history. However, there is a serious paucity in high quality data on aggravating factors and mechanisms of co-infection. This study aimed to identify the trending patterns of bacterial co-infections and types and associated outcomes in three phases of the pandemic. Using quality hospital data, we have investigated the SARS-CoV-2 fatality rates, profiles, and types of bacterial co-infections before, during, and after COVID-19 vaccinations. Out of 389 isolates used in different aspects, 298 was examined before and during the pandemic (n=149 before, n=149 during), death rates were 32% during compared to only 7.4% before pandemic with significant association (P value = 0.000000075). Death rate was 34% in co-infected (n = 170) compared to non-co-infected patients (n = 128) indicating a highly significant value (P value = 0.00000000000088). However, analysis of patients without other respiratory problems (n=28) indicated that among the remaining 270 patients, death was 30% in co-infected patients (n=150) and only 0.8% in non-coinfected (n=120) with high significant P value= 0.00000000076. The trending patterns of co-infections before, during, and after vaccinations showed a significant decline in Staphylococcus aureus with concomitant peaks in Gram-negatives in totals of (n= 149 before/n= 149 during): Klebsiella pneumonia (n = 11/49 before/during; E. coli n=10/24, A. baumannii n=8/25, and Ps. Aeruginosa n= 5/16, and S. aureus 13/1. Nevertheless, in post vaccination phase, (n= 91) gender-specific co-infections were examined for potential differences in susceptibility. Methicillin resistant S. aureus (MRSA) dominated both genders followed by E. coli in males and females with the latter gender showing higher rates of isolations in both species. Klebsiella pneumoniae declined to third place mostly in male patients. The drastic decline in K. pneumoniae and Gram-negatives post-vaccination strongly imply a potential co-protection in vaccines. Future analysis would gain more insights into molecular mimicry.

Severe cases of SARS-CoV-2 infection are characterized by an immune response that leads to the overproduction of pro-inflammatory cytokines, resulting in damage to the lungs and other organs. This remarkable increase in cytokines and other inflammatory molecules is primary caused by viral proteins, in particular ORF8, a unique accessory protein specific to SARS-CoV-2. In addition to its role in cytokine induction, ORF8 is attributed with various other functions, including its ability to evade type I interferon responses. Despite the evidence, the mechanisms through which ORF8 exerts these functions remains a subject of controversy. In this mini review, we discuss the multifaceted roles of ORF8 as a modulator of cytokine response, focusing on type I interferon and IL-6. We also discuss data from our studies indicating that ORF8 augments production of IL-6 induced by Poly(I:C) in human embryonic kidney (HEK)-293 and monocyte-derived dendritic cells (mono-DCs).

The COVID-19 pandemic has had a substantial impact on global health, notably the virus's association with autoimmune illnesses. Autoimmune illnesses occur when the immune system of the body targets healthy cells, causing damage and inflammation. The potential impact of COVID-19 on autoimmune disorders, the hazards of COVID-19 vaccinations for persons with autoimmune diseases, and the potential risks of COVID-19 vaccines are all discussed in this essay. COVID-19 can cause autoimmune illnesses by causing inflammation, organ and tissue damage, and molecular mimicry, in which the immune system mistakenly assaults healthy cells for the virus. However, not everyone infected with COVID-19 develops autoimmune disorders. While some research has found a link between COVID-19 and autoimmune illnesses, this does not always suggest causation. Other factors, such as genetics and environment, may also play a role in the emergence of autoimmune illnesses. COVID-19 can aggravate existing autoimmune disorders by causing the immune system to attack healthy cells, making management more difficult and increasing the risk of consequences. People with autoimmune disorders, on the other hand, may not be at a higher risk of severe COVID-19 than the general population. Some research has found that persons with autoimmune disorders are more likely to have severe COVID-19, whereas others have found no difference. COVID-19 vaccinations may represent dangers to persons with autoimmune illnesses since they contain antigens that can activate the immune system. Furthermore, due to their already overactive immune systems, some vaccines may not perform as well for people with autoimmune disorders, and some people with autoimmune diseases may have severe reactions to immunizations, producing inflammation and other symptoms. COVID-19 may not be any more hazardous to those with autoimmune illnesses than it is to the general population. The connection between COVID-19 and autoimmune disorders is complicated and under investigation. While some research implies that people with autoimmune disorders have a higher risk of severe COVID-19, others demonstrate no difference in death rates between them and the general population. There are also counterarguments that COVID-19 can induce and exacerbate autoimmune disorders, as well as worries about COVID-19 vaccine hazards for people who have autoimmune diseases. More research is required to completely understand the influence of COVID-19 on autoimmune illnesses, as well as the dangers and benefits of vaccinations for these people.

The COVID-19 pandemic caused by the virus SARS-CoV-2 has been the greatest global threat to human health in the last three years. The most widely used methodologies for the diagnosis of COVID-19 are quantitative reverse transcription polymerase chain reaction (RT-qPCR), used to detect the viral genome, and rapid antigen tests (RATs), also known as lateral flow tests, that employ specific antibodies to detect the viral spike protein. While PCR is considered the gold standard test in terms of specificity and sensitivity, it is time-consuming and requires specialized instrumentation operated by skilled personnel. In contrast, RATs can be used in-home or at point-of care but are less sensitive leading to a higher rate of false negative results. An alternative methodology for the detection of virus is the use of electrochemical biosensors that employ disposable strip electrodes to which binding of viral components elicits a change in electrical signal. Laser-scribed graphene (LSG) electrodes are attractive candidates for use as biosensors electrodes suitable for SARS-COV-2 detection due to their low-cost, patternability and ease of fabrication. In this work, we describe the development of a biosensor for COVID-19 detection that exploits a split-ester bond ligase system (termed ‘EsterLigase’) for immobilization of a virus-specific nanobody to maintain the out-of-plane orientation of the probe to ensure the efficacy of the probe-target recognition process. An anti-spike VHH E nanobody, genetically fused with the EsterLigase domain, was used as the specific probe for the spike receptor-binding domain (SP-RBD) protein as the target. The recognition between the two was measured by the change in the charge transfer resistance, determined by fitting the electrochemical impedance spectroscopy (EIS) spectra. The developed LSG-based biosensor achieved a linear detection range for the SP-RBD from 15 pM to 150 nM with a sensitivity of 0.0866 [log(M)]-1 and a limit of detection (LOD) of 7.68 pM.

AbstractBackground: The World Health Organization (WHO) said the situation in India was a "devastating reminder" of what the coronavirus could do. COVID-19 cases suddenly spiked across India. Union Health Minister Harsh Vardhan has said that one of the major reasons for the spike in coronavirus cases was people not following COVID-appropriate behaviour. The Union minister noted that the sudden rise in cases is largely or maybe event-driven comprising local body elections, grand weddings, and farmers' protest. These events may cause asymptomatic covid-19 carriers to spread wide covid-19 to others. Malaysia is also facing a surge in Covid-19 may due to the spread of covid-19 by asymptomatic covid-19 carriers. Therefore, it is important to develop an application that can publicize information on asymptomatic covid-19 carriers. The purpose of this application is to provide sufficient information and scientific research evidence to ensure that prevention strategies for asymptomatic covid-19 carriers must be implemented. The app is also open to anyone who uses it to educate others so that information can be shared more quickly to prevent other countries from becoming "Second India or Malaysia".Method: The homepage of the app shows that asymptomatic covid-19 carriers may have a lower viral load, the same viral load, or a higher viral load than symptomatic covid-19 carriers. When the user app is pressed by each category, they will see sufficient information and scientifically based research evidence about each category. These apps also show the evidence that on January 13, 2021 - Malaysian Health Department Director Dr Noor Hisham Abdullah instructs test Only those Close Contacts With Symptoms and The Malaysian Medical Association (MMA) has urged the Health Ministry to urgently improve the management of mild Covid-19 cases and revert to its policy of testing all close contacts. In addition, These apps also show App raise public awareness of the importance of COVID-19 vaccination(version 4) [Peter Chew, 2021] can intuitively see that countries with high vaccination rates can solve the problem of asymptomatic transmission of covid-19 carriers.Result: This application displays sufficient information and scientifically based research evidence to prove asymptomatic covid-19 carriers are the main key to the outbreak of covid-19. Some countries are using covid-19 symptom prevention strategies. They are only testing the symptomatic closed contact of covid-19 patients, because they may think that asymptomatic covid-19 carrier is just a low viral load and a low transmission rate, which is wrong. Some asymptomatic covid-19 carriers of covid-19 have high viral loads. The accumulation of asymptomatic covid-19 carriers with high viral load is the main cause of the covid-19 outbreak. Conclusion: Three apps have been developed to educate the public about the importance of asymptomatic covid-19 carriers. The asymptomatic covid-19 carrier education app (1) will provide sufficient information and scientific research evidence to educate citizens of any country to ensure that preventive strategies must be implemented for asymptomatic carriers to prevent the country’s Covid-19 outbreak. App, Game Base Learning to Prevent Infection from COVID-19 (version 3) [Peter Chew, 2020 ]. The app allows anyone to intuitively see that when the second wave covid-19 arrives, the accumulation of a large number of asymptomatic carriers in some countries has led to the high infection rate of covid-19. This is what is happening in India now. App raise public awareness of the importance of COVID-19 vaccination(version 4) can intuitively see that countries with high vaccination rates can solve the problem of asymptomatic transmission of covid-19 carriers. This is what is happening in Israel now.

The study aimed to evaluate the after-effects of the COVID-19 pandemic on the sleep quality and patterns of women across different cultural settings within Iraq, spanning the period of 2022. A cross-sectional survey was administered to a diverse cohort of women from multiple provinces in Iraq. The survey measured various parameters, including sleep duration, onset latency, and disturbances. The post-pandemic period has seen a notable decline in sleep quality among the female population. Contributing factors include psychological stress, lifestyle changes due to the pandemic, and ongoing socio-economic challenges. The impact on sleep quality exhibited variation across different cultural groups, indicating a significant cultural influence on the pandemic's psychological aftermath. The study concludes that the post-pandemic phase has adversely affected the sleep health of women in Iraq, with cultural factors playing a critical role in these changes. There is a pressing need for culturally sensitive public health strategies to address sleep disturbances and mitigate their long-term effects on women's health. Public health initiatives should be tailored to address the specific cultural contexts within Iraq to improve sleep health among women. Further research is warranted to explore the long-term consequences of disturbed sleep patterns and the effectiveness of different intervention strategies.

Laboratory analyses reveal significant differences between vaccinated and unvaccinated patients in parameters like C-reactive protein, ferritin, and white blood cell counts. Univariate and multivariate Cox proportional hazards regression analyses identify several factors influencing mortality, including comorbidities, pneumonia development, and various inflammatory markers.

Physicians exposed to a risky environment experience burnout, which negatively impacts patient care, stress decreases compassion, harms patient-doctor communication and may jeopardize patient safety. Patients are directly exposed to their physicians' overload and can sense their exhaustion, making them a sensitive seismograph of burnout. This study aimed to compare patients' standpoints towards physicians' burnout before and during the COVID-19 pandemic, characterizing patients' perceptions according to the 4 components of burnout. Two cross-sectional surveys (February-March 2018 and 2021) were conducted. 314 responders, 133 in 2018 and 181 in 2021. Physician burnout, accountability, empathy towards doctors ("mirror reflection") and the expected patient-doctor partnership were measured. Patients' perception of physicians' burnout was significantly associated with urban community, education and religiosity. Perceived accountability was associated with female gender and education. Empathy was associated with employment and gender. Patients described physicians' burnout as significantly higher prior to the COVID-19 pandemic. Physicians' accountability, empathy for doctors, and perceived partnership were more intense in 2021, implying that the emergency emphasized the physician's role and the patient-doctor relationship. Global disasters may have an unexpected positive effect on how patients understand the role and duty of physicians and the health system.

Nudging has often been suggested as a means to promote health care efficiency and effectiveness by influencing behavior without restricting choice; its usefulness however has not been adequately assessed. We examined the effect of an altruistically framed awareness message about the novel coronavirus on the intention to comply with individual prevention measures against infection. 425 Greek postgraduate students, that were randomly assigned into a treatment and a control group, filled out a questionnaire on compliance and future intention to comply with six preventive measures. Results indicate that the altruistic message did not manage to influence intention to comply. Moreover, compliance was positively associated with risk perception, whereas women showed both higher compliance and risk perception than men. Vulnerability to novel coronavirus and positive vaccination status against it were accompanied by greater perception of risk, while the personal history of COVID-19 was associated with lower intention to comply, lower risk perception and higher health risk preferences. We conclude that nudging interventions should be evaluated before being adopted in practice, taking into account timing, target groups and means of communication.

Background: COVID-19 is a respiratory illness caused by SARS-CoV-2 that has become a global pandemic. Although children can contract the virus, they are generally less likely than adults to develop severe symptoms. Parents and caregivers should monitor their children for symptoms and seek medical attention if their child becomes ill. Practicing good hygiene and social distancing can help prevent the spread of the virus. Vaccines are available for children and can provide additional protection against COVID-19. Understanding the impact of COVID-19 on children is crucial for developing effective public health strategies to control the pandemic.Objectives: The current study aims to determine the prevalence of Covid-19 in pediatric age group in Duhok province and Zakho city, in Kurdistan region. among the children who tested positive for IgG test. If IgG antibodies are detected in a person's blood sample, it suggests that they have been infected with SARS-CoV-2 at some point in the past and their immune system has responded by producing antibodies against the virus.Methods: A cross-sectional investigation was undertaken involving youngsters aged 5 to 12 years. The study encompassed a total of 330 participants, selected between October and December 2022. The children underwent testing to detect IgG antibodies. Moreover, a questionnaire was employed to gather demographic and individual information from each contributor.Results: Among the studied sample, 302/330 (91.5%) of children were positive to IgG antibody test. No gender difference for COVID-19 was found in pediatric age group. Case fatality rate was 0%. 22/302 (6.6%) cases were symptomatic during the infection. However, 282(93.4%) cases were asymptomatic. Conclusions: Covid-19 infection in pediatric age group has good prognosis compared to adults. Intensive care unit (ICU) and death are rare. High-risk groups should be targeted for education and immunization/vaccination. Furthermore, more studies are needed to be conducted in order to investigate the risk factors of the infection and to assess the awareness among the general population about the risk of infection.

Background: The risk to physicians who worked with patients without confirmed COVID-19 testing during the pandemic has been little studied. However, they were at high risk. Methods: A total of 1285 Romanian physicians completed an online survey. We performed Mann-Whitney comparisons between physicians who reported that they knowingly had direct contact with COVID patients and those who didn't regarding their willingness to work. Results: Compared with their colleagues, physicians who reported not knowingly having direct contact with COVID patients reported less access to protective equipment, less overall willingness to respond when asked to work with infected patients, more likely to work out of fear of losing their jobs, and fear of legal repercussions. They received less training in the use of protective equipment. Conclusions: Physicians who worked with patients not yet diagnosed with COVID-19 were significantly less willing to work. The perception of invisible risk may explain the observed differences.

Solid waste management is challenging in many countries, especially developing economies. The impacts of the pandemic continue to be felt and have indicated secondary impacts on waste management. This work draws on data on household solid waste (HSW), healthcare waste (HCW), and recyclables collected in the Rio de Janeiro municipality, analyzed from January 2018 to December 2022. As expected, the collection of HCW in Rio de Janeiro municipality experienced a noticeable increase in 2020 and 2021, with an average of 46.9 tons and 54.3 tons collected, respectively. Notably, 2021 saw a significant 30% increase compared to 2019 (p-value<0.001). No significant difference was observed in recyclables collected from 2018 to 2021. The average recyclable amount was 3,638 and 3,747 tons per month in 2020 and 2021. In contrast, the monthly amount was equal to 4,819.5 tons in 2022, representing an increase higher than 32% compared to previous years (p-value<0.05). Our findings can be used to adapt and improve waste systems to cope with similar emergency scenarios in the future, serving as a template for municipalities with similar challenges.

Abstract: (1) Background: The Covid-19 pandemic has spread globally since January 2020 and is a threat to public health. This study aims to highlight the psychosocial impact on Greek nursing students and the challenges they received regarding the new sustainable educational reality, in the context of the sudden and exclusive application of distance education during the pandemic Covid-19; (2) Methods: Questionnaires were distributed through an online form (Lime Survey) to undergraduate nursing students enrolled in online courses. Data were collected between De-cember 2020 and January 2021 (3) Results: A total of 341 participants were included in the study. Some of the participants (9.1%) reported that being unemployed because of the Covid-19 affected their sustainability of life. Similarly, distance education had a negative impact on students' par-ticipation in social activities with their classmates (64.5%), while many of the participants were concerned that the sudden transition from face-to-face to distance education would have a negative impact on their future career (46.3%). Furthermore, the majority of students in this study seemed to disagree that distance education could be more effective than face-to-face education (72.1%); (4) Conclusions: It is undoubtedly proven that the effects of the Covid-19 pandemic have a great impact on the educational sector. These social and psychological changes endangered the viability of students in the Greek educational reality.

Background Healthcare workers (HCWs) have suffered considerable morbidity and mortality during the COVID-19 pandemic. Few data on COVID-19 vaccine effectiveness (VE) are available from middle-income countries in Europe. We evaluated primary series COVID-19 VE against laboratory-confirmed COVID-19 among HCWs in Georgia. Methods HCWs in six hospitals in Georgia were invited to enroll in a prospective cohort study conducted during March 19–December 5, 2021. Participants completed weekly symptom questionnaires. Symptomatic HCWs were tested by RT-PCR and/or rapid antigen test (RAT), and participants were routinely tested for SARS-CoV-2 by RT-PCR or RAT, regardless of symptoms. Serology was collected at enrolment, and quarterly thereafter, and tested by electrochemiluminescence immunoassay for SARS-CoV-2 antibodies. We defined primary series vaccination as two doses of COVID-19 vaccine received ≥14 days before symptom onset. We estimated VE as (1-hazard ratio)*100 using a Cox proportional hazards model with vaccination status as a time-varying covariate. Estimates were adjusted by potential confounders that changed the VE estimate by more than 5%, according to the change-in-estimate approach. Results Overall, 1561/3849 (41%) eligible HCWs enrolled and were included in the analysis. The median age was 40 (IQR: 30-53), 1318 (84%) were female, and 1003 (64%) had laboratory evidence of prior SARS-Cov-2 infection. At enrolment, 1300 (83%) were unvaccinated; By study end, 1082 (62%) had completed a primary vaccine series (69% BNT162b2 (Pfizer-BioNTech); 22% BBIBP-CorV (Sinopharm); 9% other). During the study period, 191(12%) participants had a new PCR- or RAT-confirmed symptomatic SARS-CoV-2 infection. VEa gainst PCR- or RAT- confirmed symptomatic SARS-CoV-2 infection was 58 (95%CI: 41; 70) for all primary series vaccinations, 68% (95%CI: 51; 79) for BNT162b2, and 40% (95%CI: 1; 64) for BBIBP-CorV vaccines. Among previously infected HCWs, VE was 58% (95%CI: 11; 80). VE against medically attended COVID-19 was 52% (95%CI: 28; 68), and VE against hospitalization was 69% (95% CI: 36; 85). During the period of predominant Delta variant circulation (July-December 2021), VE against symptomatic COVID-19 was 52% (95%CI: 30; 66). Conclusions Primary series vaccination with BNT162b2 and BBIBP-CorV was effective at preventing COVID-19 among HCWs, most of whom had previous infection, during a period of mainly Delta circulation. Our results support the utility of COVID-19 primary vaccine series, and the importance of increasing coverage, even among previously infected individuals.

Severe Acute Respiratory Disease Syndrome Coronavirus 2 has caused a global pandemic. Monoclonal antibodies, antiviral therapy (Remdesivir) and immunomodulatory agents represent one of the most promising therapies to prevent disease progression and reduce the relative risk of severe COVID-19. The aim of this study was to evaluate the impact on the disease progression of the main pharmacological options approved for the patients admitted in hospital with acute COVID-19 infection, according to their vaccination status.. We conducted a study including adult patients with confirmed COVID-19 admitted to the Infectious Diseases Unit of Alessandria’s Hospital in Italy, from October 2021 to March 2022. 102 patients were included in the analysis. The mean age was 69.2 ±15.4 years, 66.7% were males. According to the internal hospital’s guidelines, 47.06% patients with mild to moderate disease were treated with mAbs, 45.10% were treated with Remdesivir, of which 10.78% received combination therapy with mAbs. The most frequently complications were pneumonia (18.63%), respiratory failure (15.68%) and acute respiratory distress syndrome (13.72%). The mean length of hospitalization was 13.42 (±10.90) days and the mortality rate was 11.76%. The treatment with mAbs and immunomodulatory therapy for mild to moderate COVID-19 infection seem to be effective to improve the outcome reducing disease progression and mortality. C-reactive protein (CRP) and ferritin could be considered a good inflammatory marker of disease progression.

Introduction: Bystander CPR rates have increase from 15% to 30% in many countries over the last 20 years. However, these gains are at risk of being lost in the face of fear of transmission of the SARS-COV-2 virus given the global COVID-19 pandemic. This survey study was designed to examine the opinions and perceptions of the Canadian public on bystanderism as it relates to out-of-hospital cardiac arrest during the COVID-19 pandemic with a view to understanding the implications of those opinions on our expectations of bystanders during, and after the pandemic. Methods: In order to capture a pan-Canadian sample of the general public, we engaged with a well-established public opinion polling vendor, IPSOS (www.ipsos.com), to conduct a robust survey on public willingness to do bystander CPR in the context of the global COVID-19 pandemic. Results: A total of n=1,000 surveys were completed by Canadian adults using the IPSOS eNation Canadian Online Omnibus survey platform.In summary there were five key findings from this pan-Canadian survey: 1) the ability to recognize cardiac arrest remains a point of confusion for the lay public, 2) at the time of the survey only about half of respondents said they would respond to someone having cardiac arrest, 3) the majority of respondents said the pandemic has changed their willingness to respond to someone in cardiac arrest, 4) willingness to use an AED is low and the greatest barrier was reported as lack of experience, and lastly 5) most Canadians say it is important to be certified in CPR and are willing to take a CPR training course, however only half are willing to pay for it. Conclusion: Bystander CPR is an out-of-hospital cardiac arrest victim’s best chance of survival and so our understanding of how we encourage more citizens to respond given the current realities is more crucial than ever. Wider dissemination of the growing evidence on the safety of CPR in the context of COVID-19 and resuscitation training courses implemented with specific CPR maneuvers to reduce the risk of infection should be implemented to continued uncertainty and erosion in bystander CPR culture.

Using publicly available data for 28 EU/EES countries from Eurostat and Our World in Data, we investigate how the current rate of Covid vaccination in a country compares to its average rate of excess mortality (EM) in the pandemic to date. We find that, in the linear regression, the correlation between average EM and vaccination rate is strongly negative, a priori evidence to support the claim that the Covid vaccines have saved many lives. However, a closer analysis of the timeline suggests otherwise. The correlation was already strongly negative before the vaccines were rolled out and is only weakly negative thereafter. In theory, survivor bias could still explain this shift, especially since waves of EM closely align with Covid waves. However, we find in addition that about half of our 28 countries experienced higher EM in 2022 than in 2021, and all that did so have higher than average vaccination rates. This is something which survivor bias cannot explain and raises the real possibility that the vaccines have not just failed to save many lives, but may have already caused net harm. Moreover, any such harm may be ongoing since we find that EM and vaccination rates have been consistently positively correlated since April 2022. We show that all these findings are robust to several different ways of measuring EM and/or vaccination rates. Finally, using public data from Worldometers, we show that the correlation over time of official Covid mortality rates with current vaccination rates closely tracks that of EM rates, even as Covid mortality has waxed and waned and even in the post-omicron period.

Coronavirus Disease 2019 (COVID-19) is an infectious respiratory illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease, first identified in the Chinese city of Wuhan in November 2019 and has since spread worldwide, is the latest human pandemic, and has officially infected over 800 million people and has caused nearly seven million deaths to date. Although SARS-CoV-2 belongs to the large family of coronaviruses, it has some unique biological characteristics in its interplay with the human host. Therefore, this narrative review aims to provide an up-to-date overview of the structure of the virus, incubation and shedding in the human host, infectivity and biological evolution over time, as well as the main mechanisms for invading human host cells and replicating within. We also proffer that ongoing epidemiological surveillance of newly emerged variants must always be accompanied by biological studies aimed at deciphering new advantageous traits that may contribute to increasing virulence and pathogenicity, such that the most appropriate strategies for establishing a (relatively) safe coexistence with the human host can be implemented.

The analysis reported here is unique in that it is the first study of the original data from the Pfizer/BioNTech BNT162b2 mRNA vaccine clinical trial (CA4591001) to be carried out by a group unaffiliated with the trial sponsor. Our study is a forensic analysis of the 38 trial subjects who died between July 27, 2020, the start of Phase 2/3 of the clinical trial, and March 13, 2021, the data end date of their 6-Month Interim Report. Phase 2/3 of the trial involved 44,060 subjects who were equally distributed into two groups and received Dose 1 of either the BNT162b2 mRNA vaccinated or the Placebo control (0.9% normal saline). At Week 20, when the BNT162b2 mRNA vaccine received Emergency Use Authorization from the U.S. FDA, subjects in the placebo arm were given the option to be BNT162b2 vaccinated. All but a few accepted. Surprisingly, a comparison of the number of subject deaths per week during the 33 Weeks of this study found no significant difference between the number of deaths in the vaccinated versus placebo arms for the first 20 weeks of the trial, the placebo-controlled portion of the trial. After Week 20, as subjects in the Placebo were unblinded and vaccinated, deaths among this still unvaccinated cohort of this group slowed and eventually plateaued. Deaths in the BNT162b2 vaccinated subjects continued at the same rate. Our analysis revealed inconsistencies between the subject data listed in the 6-Month Interim Report and publications authored by Pfizer/BioNTech trial site administrators. Most importantly, we found evidence of an over 3.7-fold increase in number of deaths due to cardiovascular events in BNT162b2 vaccinated subjects compared to Placebo controls. This significant adverse event signal was not reported by Pfizer/BioNTech. Potential sources of these data inconsistencies are identified.

Delineating the epidemic of vaccine injury from the coterminous condition long covid is a challenging prospect, but one with many implications not just for treatment, but also has important legal considerations for settlements of vaccine injury. The shared etiological factor of the spike protein in both vaccine injury and long covid make differentiation difficult, and while treatment is largely similar between vaccine injury and long covid, there are important distinctions. Furthermore, diagnostics are important for monitoring treatment progress and assessing the extent of subclinical vaccine injury in population having received a covid-19 vaccine. The development of rigorous diagnostics is an important step towards the recognition of both long covid and vaccine injury, as those suffering these conditions have faced immense challenges in having their conditions recognized, treated, and compensated by insurance companies or national health services.

Aims: The aims of this meta-analysis were to assess: the prevalence of Post-Acute COVID-19 sequalae in HIV positive patients; average time of diagnosis; and meta-regress for possible moderators of PACS.Methods: A standard search strategy was used in PubMed, and then later modified according to each specific database to get the best relevant results. These included Medline indexed journals; PubMed Central; NCBI Bookshelf and publishers' Web sites in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Search terms included “long COVID-19 or post-acute COVID-19 syndrome/sequalae”, “persons living with HIV or HIV. The criteria for inclusion were published clinical articles reporting HIV in association with long COVID-19, further, the average time to an event of post-acute COVID-19 sequelae among primary infected patients with COVID-19. Random-effects model was used. Rank Correlation and Egger's tests were used to ascertain publication bias. Sub-group, sensitivity and meta-regression analysis were conducted. A 95% confidence intervals were presented and a p-value < 0.05 was considered statistically significant. Review Manager 5.4 and comprehensive meta-analysis version 4 (CMA V4) were used for the analysis. The review/trial was PROSPERO registered (CRD42022328509).Results: A total of 43 studies reported post-acute COVID-19 syndrome. Of those, five reported post-acute COVID-19 sequalae in PLHIV. Prevalence of post-acute COVID-19 sequalae was 43.1% (95% CI 20.5% to 68.9%) in persons living with HIV (PLWH). The average time to PACS diagnosis was 4 months at 64% [0.64 (95% CI 0.230, 0.913) (P < 0.0000), I²= 93%] and at one year to PACS diagnosis was at 70 %, however with non-significant correlation (P > 0.05). On comorbidities, asthenia was associated with PACS at 17.6 % [0.176 (95% CI 0.067, 0.385) (P = 0.008), I²= 86%] while fatigue at 82%, however not related with PACS event incidence (P < 0.05). Americas, Asian and European regions showed PACS events rates of 82%, 43% and 19 % respectively (P<0.05) relative to HIV infection. Conclusion: PACS prevalence in PLWH was 43% occurring at an average time of 4 months at 64% and 70 % at 12 months however non-significant with PACS. Asthenia was significantly associated with PACS at 17.6 % while fatigue at 82%, however not related with PACS event incidence. Americas recorded the highest PACS event rates in PLWH.

This study is a two-phase hybrid study on the behavioral activities of undergraduate students during the COVID-19 pandemic lockdown. A questionnaire survey of students during the whole school period and a semistructured interviews with 13 undergraduates of different majors were conducted. First, we found that compared with primary and secondary school students, undergraduates showed many problems with self-time management. Second, the behavior of undergraduates at home may result from multiple factors, such as past experience, professional identity and behavioral habits. When secondary school provided a relatively relaxed learning environment or secondary school teachers placed more emphasis on continuous effort, and when students had a strong sense of the social value of their undergraduate major, students worked harder and achieved more during the pandemic. Otherwise, it was easier for students to slack off and be passive during the pandemic. Altogether, this study deepens our understanding of undergraduates' self-management of free time, and the differences in the values underlying different behaviors and the formation process of various behaviors.

Background: To our knowledge, the sudden onset of symptomatic pulmonary hypertension after COVID-19 vaccination has not been described. Both cases presented here resulted in functional limitations and likely permanent organ damage. Case Summary: We report two cases of acute onset pulmonary hypertension in previously healthy adult males within three weeks of receiving the second dose of the Pfizer (BNT162b2) mRNA COVID-19 vaccine from different lots. Both patients experienced the sudden onset of severe fatigue and dyspnea on exertion with negative COVID-19 PCR testing. The diagnosis was made by serial transthoracic echocardiography in the first case and by both transthoracic echocardiography and right heart catheterization in the second. Discussion: Pulmonary hypertension is a serious disease characterized by damage to lung vasculature and restricted blood flow through narrowed arteries from the right to left heart. The onset of symptoms is typically insidious, progressive and incurable, leading to right heart failure and premature death. The World Health Organization (WHO) classifies pulmonary hypertension into 5 categories and recently re-defined as a resting mean pulmonary artery pressure greater than 20 mmHg. Sudden onset pulmonary hypertension would only be expected in the settings of surgical pneumonectomy or massive pulmonary emboli with compromise of at least 50% of the lung vasculature.

The COVID-19 pandemic has caused unprecedented challenges in the care of children with cerebral palsy (CP) and other neuromuscular complex chronic conditions (NCCC). The purpose of this study was to explore the direct impact of the COVID-19 pandemic on healthcare delivery. From May to August 2020, medical professionals caring for CP and NCCC patients across multiple countries and disciplines completed a self-administered cross-sectional survey comparing practices before and during the COVID-19 pandemic. Of the 79 healthcare workers from 8 countries who participated—predominantly pediatric orthopedic surgeons (32%), pediatricians (30%), and pediatric physiatrists (23%)—most felt that caring for NCCC patients during the pandemic presented with unique difficulties and reported a significant decrease in in-person NCCC clinic volume (p<0.001), multidisciplinary appointments (p<0.001), surgical cases (p=0.005), and botulinum toxin/phenol injections. Most providers affirmed that institutional guidelines for perioperative emergent/urgent and elective procedures, workplace settings, and technology were modified to accommodate the ongoing public health crisis. Usage of telemedicine significantly increased for NCCC patient visits (p<0.001). During the COVID-19 pandemic, many children with NCCC lost access to routine, multidisciplinary care. Telemedicine became an integral part of communication and management. In the setting of the COVID-19 pandemic and threat of future healthcare disruptions, these data lay the foundation for trending the evolution of healthcare delivery and accelerating best practice guidelines for children with CP and NCCC.

Traditional vaccines are produced by using weakened or inactivated forms of disease-causing pathogens to produce the target antigen they are designed to protect against. Messenger RNA vaccines are a class of vaccines that employ a minute segment of genetic material, known as messenger RNA (mRNA), which contains directives for the cells in the body to generate a particular protein. This genetic material is synthesized in the laboratory and packaged into a lipid nanoparticle, which protects and helps it enter cells for further protein synthesis. During vaccination with mRNA vaccine, the lipid nanoparticles containing the mRNA are injected into the muscle of vaccinees. Once inside the cells, the mRNA instructs the cells to produce a protein which is then displayed on the surface of the cell, triggering an immune response. During this, the immune system recognizes the displayed protein as foreign and mounts a defense by producing antibodies and activating immune cells to target and eliminate the protein. Furthermore, these immune responses generate a memory cell, facilitating the immune system to promptly react in case of encountering the authentic pathogen as an infection in the future. The mRNA vaccines are flexible and the sequence can be easily synthesized in the lab based on the genetic information of the target pathogen. Additionally, mRNA vaccines can be developed for new strains or variants of the target disease easily. This was particularly evident during the COVID-19 pandemic, where mRNA vaccines like the Pfizer-BioNTech and Moderna vaccines were developed and authorized for emergency use within a year. But currently, available mRNA vaccines require extensive cold chain, antigen delivery, potential immune response variability optimization, and sophisticated manufacturing process. The efforts to explore next-generation mRNA vaccine development are aimed to further improve the effectiveness, stability, and delivery methods. One focus of research has been to enhance the stability of mRNA vaccines, particularly temperature sensitivity which makes storage and distribution easier, particularly in regions with limited access to cold chain infrastructure. Self-amplifying mRNA vaccines, on the other hand, are designed to generate multiple copies of the mRNA within cells which potentially leads to a higher production of the target protein, resulting in a stronger immune response. Additionally, studies are exploring new delivery systems to improve the target and efficiency of mRNA vaccines using specialized nanoparticles and liposomes to specifically deliver mRNA to certain cell types or immune cells. Another area of interest is the development of combination vaccines, where multiple mRNA sequences are included in a single vaccine protecting against multiple diseases targeting strains or variants of a particular pathogen simultaneously. While current mRNA vaccines are administered via intramuscular injection, studies are underway to deliver directly into the skin offering enhanced immune response and the ability to use smaller vaccine doses.

The Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with a high rate of mortality in kidney transplant recipients (KTRs). The current vaccine strategy for KTRs seems to be unable to provide effective protection against coronavirus disease 2019 (COVID-19) [2] and the occurrence of severe COVID-19 in some vaccinated KTRs suggested a lack of immunity. We analized here the antibody response in a group of 32 kidney transplant recipients (KTR) followed at the Nephrology and Dialysis unit of the Hospital Pio XI of Desio, Italy, compared with a group of 23 healthy workers classified as Late responders (HCW-LR) (10 males age 27-62) and 13 females (age 46-64). We observed that the patients need additional vaccine boosters due to their immunocompromised status and therapy to protect them from infections related to viral variants, in accordance with the literature.

The prediction of corticosteroid responses in coronavirus disease 2019 (COVID-19) patients is crucial in clinical practice, and exploring the role of artificial intelligence (AI)-assisted analysis of chest radiographs (CXR) is warranted. This retrospective case-control study involving hospitalized COVID-19 patients treated with corticosteroids was conducted from September 4th, 2021, to August 30th, 2022. The primary endpoint of the study was corticosteroid responsiveness, defined as the advancement of two or more of the eight-categories-ordinal scale. Serial abnormality scores for consolidation and pleural effusion on CXR were obtained using a commercial AI-based software based on days from onset of symptoms. Amongst the 258 participants included in the analysis, 147 (57%) were male. Multivariable logistic regression analysis revealed that high pleural effusion score at 6–9 days from onset of symptoms (adjusted odds ratio of [aOR]: 1.022, 95% confidence interval [CI]: 1.003-1.042, p=0.020) and consolidation scores up to 9 days from onset of symptoms (0-2 days: aOR: 1.025, 95% CI: 1.006-1.045, p=0.010; 3-5 days: aOR: 1.03 95% CI: 1.011-1.051, p=0.002; 6-9 days: aOR; 1.052, 95% CI: 1.015-1.089, p=0.005) were associated with an unfavorable corticosteroid response. AI-generated scores could help intervene in the use of corticosteroids in COVID-19 patients who would not benefit from them

Background: COVID-19 vaccines have been a game changer in the pandemic, their extensive use was favorable compared to the burden of COVID-19 complications. Despite the low incidence of complications, it was important to analyze them carefully to understand the underlying mechanisms and predisposing factors. For instance, myopericarditis especially from mRNA vaccines, and its relatively higher prevalence in young adults and adolescents has raised a public concern about the use of this vaccine in this group. We aimed through this review to compare the age likelihood of ADEM from COVID-19 vaccines, with that reported in myopericarditis cases; secondary outcome parameters included the gender and number of doses needed to induce COVID-19 vaccines related ADEM. Methodology: A literature search has been conducted on relevant databases to retrieve all case reports/series and systematic reviews describing ADEM with possible linkage to COVID-19. Exclusion criteria included any report not including the desired outcome parameters. Our results were then qualitatively compared with a similar systematic review reporting myopericarditis from COVID-19 vaccines. Results: In 38 cases with ADEM, mean age was 49±16 compared to 25±14 in myopericarditis, females were more likely to be affected, and while most of myopericarditis cases develop after the second dose, most of ADEM cases develop after the first dose (76%). Moreover, age>56 years was more predictive of negative outcome after ADEM in the form of death or permanent vegetative state. Conclusion: The discrepancy in age, gender and number of doses needed to induce complications between ADEM and myopericarditis, signify that the tissue affected is the major orchestrator of the age, gender, and dose characteristics, and not the type of vaccines. A leakier blood brain barrier with aging, might allow easier passage of autoantibodies and cytokines into the brain while lack of inhibitory immune checkpoints in the myocardium in young age might explain the higher prevalence of those cases in young adults and adolescents.

The occurrence of the COVID-19 pandemic has affected all aspects of our routine life. Here, we briefly reveal the less paid attention aspect, vocabulary. We extracted words from online news outlets during the first three months of the pandemic. The extracted words included many aspects, which we categorised into eight classes according to their functions and implications. We found out the top three dominant classes of vocabularies with the highest frequency compared to others, namely medical, economic and governance. The temporality in the pandemic timeline was vital in making sense of the predominant vocabulary. This paper is a rare preliminary report which provides a valuable insight into future articles with much more comprehensive data and analysis.

Vaccination has proven to be one of the most effective strategies against the COVID 19 pandemic. Several studies have evaluated and confirmed its effectiveness in different populations, particularly in reducing severe outcomes such as hospitalization and death. However, the potential of vaccination to protect against infection itself has been overlooked. The aim of this study was to determine the effectiveness of the booster dose in a sample of Colombian patients during the fourth wave of COVID-19 pandemic, which was associated with the emergence and predominance of the Omicron variant. A cross-sectional study was conducted on individuals who underwent RT-PCR testing for COVID-19 detection in a dedicated laboratory in Bogotá, Colombia, between December 30th 2021 and February 7th 2022. A total of 1,468 subjects were included in the study. The comparison between fully vaccinated individuals with a booster dose and those without the booster dose revealed a 28% reduction in the odds of infection (OR = 0.719 CI 0.531 - 0.971). Age (OR = 1,009 CI 1,001 - 1,018) and low economic status (OR= 1,812 CI 1,416- 2,319) were associated with an increased risk of infection.These findings suggest the need for booster vaccination in the general population to improve the prevention rates of SARS-CoV-2 infection and mitigate severe outcomes.

Background: The Covid-19 pandemic has globally impacted the lives of individuals, families, and children. In Italy, measures such as lockdowns and distance learning were implemented in schools, which affected the mental health of children and families. Methods: This article employs qualitative methodology to explore the experiences of children, parents, and teachers during the pandemic and lockdown, as well as the implementation of a death education project aimed at primary school children to help them process emotions and losses experienced during this period. Results: Distance learning posed challenges to the learning process and exacerbated social inequalities. Children suffered from limited social contact with friends and experienced negative emotions, including anger, fear, and concern for the health of their loved ones. The death education project provided a safe space for emotional expression and facilitated the acquisition of coping strategies. Open communication between adults and children about illness and death proved effective in mitigating the psychological impacts of loss and preventing traumatic bereavement. Conclusions: The findings highlight the utility of death education in enhancing children's ability to express their emotions and approach the topic of death morefrankly.

Background: The EFLM Task Force Preparation of Labs for Emergencies (TF-PLE) created a survey that has been distributed to its members for gathering information on the key hazards experienced by European medical laboratories during the COVID-19 pandemic. Methods: The survey was distributed to over 12,000 potential contacts (laboratory workers) via an EFLM newsletter, with responses collected between May 8 and June 8, 2023. Results: Two hundred replies were collected and examined from European laboratories. 69.7% and 78.1% of all responders said they were short on non-COVID and COVID reagents, respectively. Exactly half of respondents (50.0%) said that they could not complete all laboratory tests required for a specific period, but this figure climbed to 61.2% for COVID tests. Finally, 72.3% of respondents expressed exhaustion during the pandemic, and 61.2% reported increasing patient hostility. Conclusions: The COVID-19 pandemic had a significant impact on laboratory medicine in Europe. Cultural change, proactive planning, and even re-engineering in some parts of the laboratory industry may thus be necessary to prepare for future challenges.

Background: A growing number of studies have reported Coronavirus disease (COVID-19)-related to both respiratory and central nervous system dysfunctions. This study evaluates the neuromodulatory effects of spinal cord transcutaneous stimulation (scTS) on the respiratory functional state in healthy controls and patients with post-COVID-19 respiratory deficits as a step toward the development of a rehabilitation strategy for these patients.; Methods: In this before-after, interventional, case-controlled clinical study, ten individuals with post-acute COVID-19 respiratory deficits and eight healthy controls received a single twenty-minute-long session of modulated monophasic scTS delivered over the T5 and T10 spinal cord segments. Forced Vital Capacity (FVC), Peak Forced Inspiratory Flow (PIF), Peak Expiratory Flow (PEF), Time-To-Peak of Inspiratory Flow (tPIF), and Time-To-Peak of Expiratory Flow (tPEF) were assessed before and after the intervention; Results: In COVID-19 group, the scTS intervention led to significantly increased PIF (p= .040) and PEF (p= .049) in association with significantly decreased tPIF (p= .035) and tPEF (p= .013). In the Control Group, the exposure to scTS also resulted in significantly increased PIF (p= .010) and significantly decreased tPIF (p= .031). Unlike the results in COVID-19 group, there was significantly decreased PEF (p= .028) in association with significantly increased tPEF (p= .036). There were no changes for FVC after scTS in both groups (p= .67 and p= .503); Conclusions: In post-COVID-19 patients scTS facilitates excitation of both inspiratory and expiratory spinal neural networks leading to an immediate improvement of respiratory functional performance. This neuromodulation approach could be utilized in rehabilitation programs for patients with COVID-19 respiratory deficits.

Through the ACE2, a main enzyme of the renin-angiotensin system (RAS), the SARS-CoV2 gains access into the cell, resulting in different complications which may extend beyond the RAS and impact the Arachidonic Acid (ArA) pathway. The contribution of the RAS through ArA pathways metabolites in the pathogenesis of COVID-19 is unknown. We investigated whether RAS components and ArA metabolites can be considered biomarkers of COVID-19. We measured the plasma levels of RAS and ArA metabolites using an LC-MS/MS. Results indicate that Ang1-7 levels were significantly lower, whereas Ang II levels were higher in the COVID-19 patients than healthy control individuals. The ratio of Ang1-7/Ang II as an indicator of the RAS classical and protective arms balance was dramatically lower in COVID-19 patients. There was no significant increase in inflammatory 19-HETE and 20-HETE lev-els. The concentration of EETs was significantly increased in COVID-19 patients, whereas the DHETs concentration was repressed. Their plasma levels were correlated with Ang II concentration in COVID-19 patients. In conclusion, evaluating the RAS and ArA pathway biomarkers could provide helpful information for the early detection of high-risk groups, avoid delayed medical attention, facilitate resource allocation and improve patient clinical outcomes to prevent long COVID incidence.

The challenge of accessing finance by entrepreneurs from traditional financial sources is pervasive. The COVID-19 pandemic further exacerbated the problem of limited access to finance from banks. Against this backdrop, the objective of the study was to determine the factors driving crowdfunding success during the COVID-19 pandemic in Africa. The ordinary least squares (OLS) and probit regression models were estimated to analyse 216 crowdfunding projects in Africa. The results of the study documented that targeted amount (TA), and COVID-19 pandemic were negative and significant drivers of crowdfunding success. Furthermore, comments (CMM) and duration (DRN) were negative and significantly affected crowdfunding success. Conversely, images (IM), videos (VD), backers (BCK), and updates (UPD) were positive and significantly affected crowdfunding success. The study contributes to the body knowledge by investigating the drivers of crowdfunding success during the COVID-19 pandemic period which hitherto had not been researched on extenisvely.

During the Covid 19 pandemic, we saw a huge impact on the lives of individuals in cities. The way people responded was controlled and limited. The lockdown restricted a lot of movements in the cities as well as contained the citizens in their houses. Through a semi-structured interview, the research aims to understand the change in behaviour and response of individuals across various cities. The paper aims to understand how people change their day-to-day life in cities during the pandemic and while the restrictions getting released post the first wave. The paper also understands how the pandemic impacted urban spaces and what value they hold for people. By interviewing individuals from different cities, the data were transcribed and analysed to understand this behavioural change and the attitude of people. The outcome of the research was derived as a concept map through the codes generated during the research.

The COVID-19 pandemic has affected millions of people globally, with respiratory organs being strongly affected in individuals with comorbidities. Medical imaging-based diagnosis and prognosis have become increasingly popular in clinical settings to detect COVID-19 lung infections. Among various medical imaging modalities, ultrasound stands out as low-cost, mobile, and radiation-safe imaging technology. In this comprehensive review, we focus on ultrasound-based AI studies for COVID-19 detection that use public or private lung ultrasound datasets. We surveyed articles that used publicly available lung ultrasound datasets for COVID-19 and reviewed publicly available datasets and organize ultrasound-based AI studies per dataset. We analyzed and tabulated studies in several dimensions, such as data preprocessing, AI models, cross-validation, and evaluation criteria. In total, we reviewed 42 articles, where 28 articles used public datasets, and the rest used private data. Our findings suggest that ultrasound-based AI studies for the detection of COVID-19 have great potential for clinical use, especially for children and pregnant women. Our review also provides a useful summary for future researchers and clinicians who may be interested in the field.

The years 2019 to 2022 are being marked by the pandemic resulting from a viral infection, COVID-19. The demand and use of PPE has never been so high and it is often discarded without considering the correct disposal route and the environmental impact that this type and volume of waste can generate. The aim of this study was to analyze the increased demand for PPE used during the pandemic and, consequently, the generation of these wastes. In addition to this analysis, it is extremely important to raise the discussion about the treatment of these residues and the possibilities of more ecological personal protection equipment, such as biodegradable or reusable ones. The extensive use of PPE, which is mostly plastics and is not easily degraded, mainly leads to its accumulation in landfills but, if disposed of incorrectly, it could reach marine environments, contributing to the formation of microplastics in the oceans. Therefore, this article also aims to relate these themes to the Sustainable Development Goals, as efficient management aligned with sustainable development goals is essential to mitigate these anticipated problems and ensure a more sustainable future.

Vaccine hesitancy remains a public health challenge. It has been argued that the sources of vaccine-related information may serve as important condiments to one’s decision to be vaccinated. However, little empirical attention is given to the subject. We contribute to this debate by assessing the level of COVID-19 vaccine hesitancy and the role of information explaining hesitancy, using the Nelson Mandela Bay Municipality of South Africa as a case study. Findings confirm high level of vaccine hesitancy, representing 78.8 percent of the respondents (which is above the national level of 41%). Furthermore, findings reveal that vaccination decisions are influenced by family, which is the most trusted among all institutions in the society, especially on sensitive matters and those shrouded by myths and misinformation. Additionally, the majority trusts health care workers and mass media as sources of health-related and general information; however, the use of popular personalities to convey health information is not supported. The findings reveal key socio-demographic and institutional drivers of COVD-9 vaccine hesitancy, such as age, inadequate information on the vaccine, trust issues, conspiracy beliefs, vaccine-related factors, and perceived side effects associated with the vaccine. Recommendations based on the findings are provided.

The phenomenon of vaccine hesitancy is a growing threat to public health with far-reaching implications. The widening gap between the vaccinated and the proportion needed for herd immunity raises two critical research questions that are of interest to practitioners, researchers, and policymakers: (1) What determines one’s decision to be vaccinated? and (2) What is the implication of COVID-19 vaccine hesitancy on economic recovery? In this study, we use empirical data in the context of South Africa to investigate factors affecting COVID-19 vaccine hesitancy and their implications for economic recovery. Findings reveal key socio-demographic and institutional drivers of COVD-9 vaccine hesitancy, which include age (the youth are more hesitant), inadequate information on the vaccine (those who perceive they have adequate information are vaccinated), trust issues in government institutions, conspiracy beliefs, vaccine-related factors, and perceived side effects associated with the vaccine. Additionally, an individual’s decision to remain hesitant about COVID-19 vaccination has implications for businesses and the economy by limiting movement and trade, increasing unemployment, and causing a resurgence of new variants. Based on the findings, action plans such as information dissemination, convenience vaccination centers, consistency communications, and targeted campaign strategies are recommended for improving vaccine intakes and a positive economic recovery.

Introduction. Covid-19 faced the world with serious health and socioeconomic issues. At the very beginning of the pandemics, the vaccine was considered by health authorities and the medical community the only way to curb the spread of the virus. One of the measures that have been proposed to increase vaccinations was the mandatory policy. The purpose of this study was to compare determinants of voluntary and mandatory vaccination among students of Albanian University. Methodology: This cross-sectional study by means of an online survey, was conducted among students enrolled in the private University “Albanian University”, Tirana, Albania during the last week of winter semester 7-14 Feb 2022. Results: 878 students participated in this study, among them 612 (69.7%) were females, 266 (30%) were males. 506 (57%) of the participants were enrolled in Medical Sciences (MS), 372(42.3%) were Non-Medical Science (Non-MS) group. 773 (88%) was vaccinated against Covid-19, 105 (11.8%) were not vaccinated. 466 (53%) reported voluntary vaccination, 412 (46.9%) reported mandatory vaccination. Among students that vaccinated voluntary 266 (57%) were from MS group, 200(42.9%) from Non-MS group. 237(57.5%) of students in mandatory vaccination group were from MS group, 175 (42.4%) from Non-MS. Conlusion. Vaccine safety and efficacy were hindering factors of vaccination. Also, based on the results of this study, the students felt encouraged to vaccinate by the academic staff. This clearly demonstrates that the staff does not lack the skills to enhance stu-dents' knowledge about the risk of infectious diseases and the importance of vaccination. Therefore, to influence as much as possible students’ attitude toward vaccination, comprehensive educational programs including modification of existing curricula should be considered.

Vaccination is the key infection control measure against Coronavirus Disease 2019 (COVID-19). Most municipalities in Japan have adopted an opt-in system for COVID-19 vaccination, but its background information is limited. We, therefore, aimed to examine the differences in vaccination coverages and their cancellation rates between opt-in and opt-out settings for COVID-19 vaccination in 10 cities in A prefecture, Japan. 10 cities in A Prefecture were surveyed by email as of 10 October 2021 on the vaccination coverage by age group (12 years and older) and the cancellation rate on the day of vaccination. We also checked on the complaints received in the opt-out group. Opt-out was adopted in one of the ten cities in which vaccination was designed for all household members aged 15-64, thus serving as the opt-out group. Vaccination coverage in the opt-out group was 88.2%-89.2% for the first dose and 84.9%-86.0% for the second dose at 95% confidence intervals in the comparable 20–64-year age group. In contrast, the overall opt-in group (nine cities, one of which did not have an identified vaccination rate) was 51.3%-83.6% for the first dose and 63.5%-74.8% for the second dose in the same age group. For the opt-out group, the cancellation rate on the day was 11.3% for the first dose and 3.7% for the second dose, which had a lower cancellation rate than that of the opt-out on influenza vaccines in previous studies, 71%. Meanwhile, the opt-in group did not monitor them. There were no complaints about default changes in the opt-out group. While there is room for further research, such as understanding the reasons for accepting the default change by residents in the opt-out group, it was suggested that making opt-out the default would promote COVID-19 vaccination.

The global COVID-19 pandemic has affected all spheres of human life, resulting in millions of deaths and overwhelming medical facilities. Moreover, the world has witnessed great financial hardship because of job losses resulting in economic havoc. Many sections of society have contributed in different ways to slow the spread of the virus and protect public health. For example, medical scientists are praised for their efforts to develop COVID-19 vaccines. Clinical trials have shown that the COVID-19 vaccines are highly effective in preventing symptomatic COVID-19 infections. However, many people around the world have been hesitant to get vaccinated. Vaccine misconceptions have emerged and increased due to a combination of factors, including the availability of information on the Internet and the influence of celebrities and opinion leaders. In this context, we have analyzed ChatGPT responses to relevant queries on vaccine misconceptions. The positive responses and supportive opinions provided by the AI chatbot could be instrumental in shaping people’s perceptions of vaccines and in encouraging users to get vaccinated and reduce misconceptions.

Background. The main impetus behind the worldwide Covid-19 vaccination campaign in 2021 was to reduce the mortality attributed to SARS-CoV-2 infection in the preceding year. Nevertheless, rigorous analyses of the mortality benefits conferred by this massive vaccination effort have been lacking. Methods Statistics offers us an essential methodological approach for measuring the impacts of Covid-19 vaccination on public health. The mathematical relation between vaccinated-alive groups can be repeated between vaccinated-dead groups with relatively high statistical reliability because of the large population numbers involved. This method also confers greater statistical usefulness because it eliminates the Simpson effect. Results Calculations were performed for each of the following five(5) four-week intervals: weeks 35-38 (2021), weeks 39-42 (2021), weeks 43-46 (2021), weeks 47-50 (2021), and weeks 50(2021)-1(2022). The results obtained confirm that the mortality of the vaccinated coronavirus-infected groups was 14.5% higher on average than the mortality of non-vaccinated coronavirus-infected groups. Conclusions Vaccinated infected groups appear to have higher average mortality than their non-vaccinated infected counterparts. The findings suggest the legitimacy of extending the statistics between vaccinated living and vaccinated dead individuals for different age groups. Calculating the impact of Covid-19 vaccination on the mortality rate is a necessary step towards satisfying the first principle of medicine: “Primum non nocere”, “Do no harm”.

Vaccination against SARS-CoV-2 has significantly contributed to the recent pandemic control. COVID-19 vaccines are available with different platforms and the primary clinical trials results presented acceptable safety profile of the approved vaccines. Nevertheless, the long-term assessment of the adverse events or rare conditions need to be investigated. The present systematic review, aimed at classification of Iranian case reports following COVID-19 immunization. To achieve this goal, the related published case reports were explored via PubMed, Web of Science and Google scholar according to PRISMA guideline and available up to 14th Dec, 2022. Out of 437 explored studies, the relevant data were fully investigated which totally led to 40 studies including 64 case reports with a new onset of a problem. The cases were then classified according to the various items such as the type of adverse event manifestations and COVID-19 vaccine. The reported COVID-19 vaccines in the studied cases included Sinopharm, AstraZeneca, and COVAXIN. The results showed that the adverse events presented in 8 different categories from which cutaneous problems accounted as the most prevalent manifestations (43.7%) in which rare diseases were also screened such as Steven-Johnson syndrome, Morphea and Toxic Epidermal Necrolysis. Notably, almost 60% of the cases had no comorbidities. Moreover, the obtained data revealed nearly half of the incidences occurred after the first dose of injection and the mean duration of improvement after the symptom onset was 18.72±24.69 days. 73% of all the cases were either significantly improved or fully recovered. Although the advantages of COVID-19 vaccination is undoubtedly significant, the high risk individuals including those with a history of serious disease or comorbidities immunodeficiency conditions should be vaccinated with the utmost caution.

The Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) first emerged in 2019 in China and has resulted in millions of human morbidities and mortalities across the globe. It has been shown that this novel virus originated in animals, mutated, and made the cross-species jump to humans. At the time of this communication, the Coronavirus disease (COVID-19) may be on way to an endemic form, however the threat of the virus is more for susceptible (older people and immunocompromised) people. The human body has more bacterial cells than its own, thus making us more bacterial than humans. As a consequence, the bacteriomes in the human body heavily influence human health and disease. The bacteriomes in the body and the immune system seem to be in constant association during bacterial and viral infections. In this review, we identify various bacterial spp. in major bacteriomes (oral, nasal, lung, and gut) of the body in healthy humans and compare them with dysbiotic bacteriomes of COVID-19 patients. We try to identify key bacterial spp. that have a positive effect on the functionality of the immune system and human health. These select bacterial spp. could be used as potential probiotics to counter or prevent COVID-19 infections. In addition, we try to identify key metabolites produced by probiotic bacterial spp. that could have potential anti-viral effects against SARS-CoV-2. These metabolites could be subject to future therapeutic trials to determine their anti-viral efficacy.

Cardiac complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been well-identified since the beginning of the current coronavirus disease 2019 (COVID-19) pandemic. Such conditions can occur of various etiologies, such as respiratory failure and hypoxemia, direct cardiac tissue damage due to viral replication, indirect myocarditis as systemic inflammation, and the interaction of different medications. Recently, with the start of the COVID-19 vaccination programs, COVID-19 vaccine-associated cardiac adverse events (AEs) have emerged and are increasingly being reported. Although these AEs are usually mild and self-limited, they can sometimes cause severe, catastrophic outcomes. This review compares the pathophysiology, diagnosis, and treatment of the de novo SARS-CoV-2 infection-related and COVID-19 vaccine-related myocarditis and pericarditis.

SMEs constitute the backbone of the Syrian economy which have suffered manifold challenges due to the continuous Syrian war. Covid-19 added further pressures on Syrian SMEs and force them to take certain adaptation strategies to survive. This paper aims to investigate the main challenges that face Syrian SMEs during the pandemic and illustrate how they respond to adversities emerged from governmental intervention to control the spread of the virus. It also discusses the measures initiated by the government to support SMEs during the pandemic. Through interviewing persons from the Syrian SMEs ecosystem, we find that high interest rates on SMEs loans, decline on demand as well as high inflation represent the main challenges. SMEs respond to these challenges by marketing products online, stock procurement, and strengthen connections with stakeholders. We recommend the Syrian authorities reduce lending rates and increase loan size available to SMEs to help them overcome the pandemic adversities. Moreover, SMEs will immensely benefit from training on digital tools to enhance their expansion and survival opportunities. Furthermore, bazars should be organized around the year to give SMEs the opportunity to gain continuous access to markets. In addition, incubation services should be revised, particularly, to SMEs with great potential to grow to create the suitable environment for them to scale and flourish.

While vaccines are a well-established method of controlling the spread of infectious diseases, vaccine hesitancy jeopardizes curbing the spread of COVID-19. Through the Vaccine Information Network (VIN), this study explored barriers and motivators to COVID-19 vaccine uptake. We conducted 18 focus group discussions with male and female community members, stratified by country, age group, and—for Zimbabwe only—by HIV status. Participants’ median age across both countries was 40 years (interquartile range of 22–40) and most (65.9%) were female. We conceptualized the key themes within the World Health Organization’s Strategic Advisory Group of Experts on Immunization (SAGE) 3Cs (convenience, confidence, complacency) vaccine hesitancy model. Barriers to vaccine uptake—lack of convenience, low confidence, and high complacency—included inaccessibility of vaccines and vaccination sites, vaccine safety and development concerns, and disbelief in COVID-19’s existence. Motivators to vaccine uptake—convenience, confidence and low complacency—included accessibility of vaccination sites, user-friendly registration processes, trust in governments and vaccines, fear of dying from COVID-19 and knowing someone who had died or become infected with COVID-19. Overall, vaccine hesitancy in South Africa and Zimbabwe was influenced by inconvenience, a lack of confidence, and high complacency around COVID-19 vaccines.

The outbreak of Coronavirus, as well as its emerging potential consequences, has become a global challenge worldwide, demanding effective and controlled therapeutic strategies. Potential drug candidates could achieve that with minimal toxicity. The current investigation selected 2-Deoxy-D-glucose prescribed by Defense Research and Development Organization (DRDO), India. The derivative and modified form was tested through in silico analysis against COVID-19 main protease complex with N3 inhibitor. The derived form of 2-Deoxy-D-glucose was generated by replacing the hydroxy group with a hydrogen atom, and Cypate 2-Deoxy-D-glucose was chosen as a derivative against the COVID-19 main protease complex. A molecular docking approach was adopted to identify the stable and competent form among the modified and derivative forms of 2-Deoxy-D-glucose based on binding energy. By further promoting the stabilized complex, these compounds' toxicity was also scrutinized through ADMET analysis to predict the potential candidate. The current investigation suggested that the modified version of 2-Deoxy-D-glucose was more stable with minimal toxicity against COVID-19 main protease.

Mint and to a lesser extent menthol have been used since antiquity for medicinal purposes. Key components of mint and menthol use such as composition and intake, safety and traditional uses are discussed prior to a review of clinical and human performance outcomes in the areas of digestive and respiratory health; antibacterial and anti-fungal properties, nocioception, migraine and headache and emerging evidence regarding COVID 19. Evidence suggests benefit for patients with irritable bowel syndrome and related digestive issues, with analgesic and respiratory effects also noted. Perceptual characteristics relating to thermal comfort and sensation, taste sensitivity and alertness are also considered; these effects are predominantly driven by stimulation of transient receptor potential melastatin 8 (TRPM8) activity resulting in sensations of cooling and freshness, with lesser influence on thirst. Finally, sport performance is considered as a domain that may further elucidate some of the aforementioned underpinning outcomes due to its systemic and dynamic nature, especially when performed in hot environmental conditions.

Given that population COVID-19 vaccination does not appreciably reduce SARS-CoV-2 transmission, instead, the potential to reduce hospitalization has been used to justify coercive vaccine passports. We aim to use a recently published research study as an example in order to demonstrate how data can be misinterpreted and result in deriving misleading ethical and policy implications. Bagshaw et al wrote that unvaccinated patients with COVID-19 in Alberta, Canada “had substantially greater rates of ICU admissions, ICU bed days, and ICU related costs than vaccinated patients did. This increased resource use would have been potentially avoidable had these unvaccinated patients been vaccinated.” The authors in Bagshaw et al then concluded that their findings “have important implications for discourse on the relative balance of increasingly stringent public health protection (restrictions), including mandatory vaccination policies, and the sustainability and function of health system infrastructure and capacity during the ongoing COVID-19 pandemic.” Here we show the following. First, the effect of vaccination on intensive care admissions were grossly over-estimated due to several limitations of this and almost all other vaccine studies. Second, an effect of vaccination on access to acute care and on all-cause excess deaths was grossly over-stated due to several more likely causes being omitted from discussion and from the common narrative. Third, policy implications were overstated and at best unclear due to missing consideration of more relevant aspects required to inform policy. Overall, the data cannot support what Bagshaw et al called “increasingly stringent public health protection (restrictions), including mandatory vaccination policies”.

Background Several vaccines have been approved for prevention of the coronavirus disease discovered on 31st December in Wuhan, China. Pakistan procured vaccines from various countries. However, the lack of knowledge and reluctance of the general population to embrace the use of the vaccines are considered to be the major determinants of the slow vaccination rate. Hence, it is necessary to evaluate the willingness of the general population about their perception of the COVID-19 vaccination. Methods A cross sectional survey based on a self-structured questionnaire comprising 18 questions was conducted (from April 21-June 21) on 400 Pakistani participants to evaluate their knowledge, attitude and perception towards the COVID-19 vaccination. Chi-square independent t-test and one-way Anova including a multiple step wise linear regression were used to draw conclusions about the results. P< 0.05 was considered significant. Results A total of 400 participants responded in the KAP survey of which 46.5% were female and 53.5% were male. The mean age of participants was 36.08 years. This survey showed a poor knowledge (50.5%), a fair attitude (75.1%) and a poor perception (58.1%) towards the COVID-19 vaccination. Higher mean knowledge and attitude scores was reported in the age group 21-40, females and unmarried urban citizens. Regression analysis showed that age, education, residence and employment status influenced the knowledge and perception score to a considerable extent. Conclusions The findings reflect an inadequate knowledge and perception on the one hand but a better attitude towards the COVID-19 vaccination. This KAP survey will help in better understanding the opinion of the general population towards vaccination and will be useful for policy makers and health care authorities aiming to increase the vaccination rate.

A large body of research has examined people’s attitudes toward mandatory vaccination to cope with the COVID-19 pandemic. However, studies have yet to explore how Chinese people view the COVID-19 vaccine mandates, let alone placing such views in the country’s highly politicized context. On the other hand, facing the high pressure of loosening its zero-COVID policies amidst the worldwide practices of co-existing with the COVID-19 virus, the country has to improve its vaccination coverage quickly. In this situation, it is more than necessary to systematically investigate the Chinese public’s attitude to mandatory vaccination against the virus and the underlying determinants. The current study utilizes data from a national survey adopting quota sampling to analyze the Chinese public’s medical and non-medical considerations when judging compulsory COVID-19 vaccination. The study reveals that thanks to China’s successful lockdown policies, personal risk, and benefit perceptions did not dominate their views regarding vaccination mandates. Instead, conspiracy beliefs regarding the pandemic outbreaks, conspiratorial thinking, and nationalism more strongly predicted their willingness to accept mandatory vaccination. Given the potentially massive impacts of the COVID-19 infection, if China opens its door and loosens its strict quarantine restrictions, the Chinese public needs to be educated with more medically valuable and relevant information to improve their vaccination protection against COVID-19.

Recycling and waste management have garnered immense popularity in recent years, but few studies have been carried out regarding these systems. Therefore, an in-depth literature review was done in order to highlight the different sectors of the recycling system that need to be reformed. Hence this study examined recycling and waste management systems within three categories–medical, municipal, and plastic–that were carried out pre and post COVID by reviewing previous studies, technical reports, and annual reports. This was done by visiting numerous academic search engines alongside online resources that were utilized to assemble literature related to waste and recycling systems. Continuing a recurring idea was that no matter the type of waste, further research regarding all waste should be carried out. Additionally, since recycling and waste management are a vital part of our society, and seeing how unpredictable events such as the pandemic may be, it is paramount that that research is done not only on how the pandemic has affected systems now, but also how we can learn from current issues to utilize them for future “waste shocks”.

Objectives: To analyze cumulative incidence and mortality by COVID-19 in the different types of nursing homes, in the first and second wave.Methods: Data source: Transparency portal of the Generalitat de Catalunya, official COVID-19 register of all Catalan nursing homes (from March to December 10, 2020). Variables: Affectation of disease and mortality by COVID-19 in geriatric centers in Catalonia, stratified by size of center and type of management. Univariate, bivariate and multivariate linear regression analysis, IBM^TMSPSS^® v.20.Results:N = 1,057 residences (63,682 beds, average = 60.48). 52% have <50 beds, 42.8% between 50-150 beds, and 5%> 150 beds. COVID-19: Cumulative incidence: 21,370 (confirmed + suspicious); mortality: 5,010 (confirmed + suspicious).233 residences did not register COVID-19 patients (22%) and 636 did not register COVID-19 deaths (60.2%).According to the type of supplier, the lowest incidence of COVID-19 was in non-accredited (36.2% without cases), then concerted / collaborators (19.3%) and own of the Generalitat de Catalunya (7.9 %, p = 0.000). The centers with the fewest deaths were the non-accredited (78% without deaths), followed by contracted / collaborators (56.8%) and those of the Generalitat de Catalunya (41.3%, p = 0.000).Depending on the size, no COVID-19 patients were registered: 168 centers <50 beds (30.5%); 64 of the 50-150 beds (14.2%); and 1 of the> 150 beds (1.9%) (p = 0.000). 395 of the <50 beds did not register deaths due to COVID-19 (71.8%), 232 of the 50-150 beds (51.3%), and 9 of the> 150 beds (17%) (p = 0.000).Discussion:Of the 1,057 centers analyzed, 22% did not register cases and in 60% there were no deaths from COVID-19.Residences without concert / collaboration with the Generalitat and with fewer beds showed a lower cumulative incidence and mortality due to COVID-19 during the first wave.

Abstract Introduction There is a clear link between self-medication practice and ongoing pandemic diseases like COVID-19, According to studies conducted globally and the general Ethiopian population turned to self-medication and symptomatic treatment as a result of inadequate COVID-19 treatment and also about 80% of the population amassed drugs for pandemic use. Objective: The objective of this study was to assess self-medication practice for treatment of Covid-19 and reason to use self- medication among residents in Bedelle city and its surrounding, Southwest Oromia, Ethiopia. Methodology: A cross sectional study design was employed and the standardized questionnaire was developed by reviewing relevant literatures then the data was collected using face to face interview. Final data was analyzed by using SPSS version 23. Result: The final study contained 415 respondents in total, with a response rate of 98.5%. The majority of responses were females and between the ages of 18 - 25 Category. In this study population, the use of self-medication since the onset of the Covid-19 epidemic was reported by participants were around 50.6%. Analgesics (42.4%) and cold medicines (29.5%) were the most frequently used medications for treatment of COVID-19. Also the reported uses of these drugs included treatment of Covid-19 symptoms like the Headache (22.2%), Fever (13.2%), respiratory infective (14.3%), and cold (21.4%) were the most frequently reported symptoms for self-medication. Self-medication methods were used more frequently by women than Men. Conclusion: According to this study, analgesics and cold medications are commonly self- medicated drugs used for Covid-19 therapy. It is a serious health concern, particularly when COVID-19 symptoms are present, and high consumption of self-medication has been linked to COVID-19 prevention or treatment. Key words: Covid-19, Medicine, Practice, Bedelle city, Self-Medication

Background: Medical comorbidities increase the risk of severe COVID-19 infection. In some studies, obstructive sleep apnea (OSA) has been identified as a comorbid condition that is associated with an increased prevalence of COVID-19 infection and hospitalization, but few have investigated this association in a general population. Research Question: In a general population, is OSA associated with increased odds of COVID-19 infection and hospitalization and are these altered with COVID-19 vaccination? Study Design: Cross-sectional survey of a diverse sample of 15,057 U.S. adults Results: COVID-19 infection and hospitalization rates were 38.9% and 2.9% respectively. OSA or OSA symptoms were reported in 19.4%. In logistic regression models adjusted for demographic, socio-economic and comorbid medical conditions, OSA was positively associated with COVID-19 infection (aOR: 1.58, 95%CI: 1.39-1.79) and COVID-19 hospitalization (aOR: 1.55, 95% CI: 1.17-2.05). In fully adjusted models, boosted vaccination status was protective against both infection and hospitalization. Boosted vaccination status attenuated the association between OSA and COVID-19 related hospitalization, but not infection. Participants with untreated or symptomatic OSA were at greater risk for COVID-19 infection; those with untreated, but not symptomatic OSA were more likely to be hospitalized. Interpretation: In a general population sample, OSA is associated with a greater likelihood of having had a COVID-19 infection and a COVID-19 hospitalization with the greatest impact observed among persons experiencing OSA symptoms or who were untreated for their OSA. Boosted vaccination status attenuated the association between OSA and COVID-19 related hospitalization.

Pineapple is a highly demanded fruit in international markets, thanks to its unique appearance and flavor, high fiber content, vitamins, folic acid, and minerals. It makes the pineapple production and processing market a significant source of income for producing countries, such as Costa Rica. Nowadays, its processing produces a large amount of waste with negative consequences for the environment. However, pineapple waste is an essential source of cellulose, hemicellulose, lignin, and other high-value products like enzymes (bromelain). These by-products can be obtained by pineapple waste biorefinery, generating an additional source of export goods and foreign currency, framing pineapple processing in the concept of the circular economy. This review discusses how incorporating biorefinery in the pineapple production processes can contribute to the post-COVID 19 economy in Costa Rica. Pineapple production in Costa Rica is explored, and the contamination of generated residues is delineated. Furthermore, the primary processes for by-product extraction via biorefinery, their general characteristics and applications in the medical field, and their contribution to the circular economy are presented.

The repurposing of licenced drugs for use against COVID-19 is one of the most rapid ways to develop new and alternative therapeutic options to manage the ongoing pandemic. Given the approximately 8,000 licenced compounds available from Compounds Australia that can be screened, this paper demonstrates the utility of commercially-available ex vivo/3D airway and alveolar tissue models. These models are a closer representation of in vivo studies compared to in vitro models, but retain the benefits of rapid in vitro screening for drug efficacy. We demonstrate that several existing drugs appear to show anti-SARS-CoV-2 activity against both Delta and Omicron Variants of Concern in the airway model. In particular, fluvoxamine, as well as aprepitant, everolimus, and sirolimus have virus reduction efficacy comparable to the current standard of care (remdesivir, molnupiravir, nirmatrelvir). Whilst these results are encouraging, further testing and efficacy studies are required before clinical use can be considered.

Background: Covid-19 patients with any pre-existing cardio-vascular disease (CVD) are at highest risk for viral infection and for developing of severe disease. Pathophysiological mechanism is characterized by the viral link to Angioten-sin-Converting Enzyme 2 (ACE2) and the involvement of the endothelial system with the release of cytokines and direct damage on myocardium, micro throm-bosis, and alterations of oxygen diffusion. Aim of the study is to analyze clinical course, treatment and outcome in patients (gender stratified) with pre-existing CVD. Methods: Out of the 1299 (700 M/599 F) patients admitted to Internal Medicine COVID Unit of “Castelli Hospital”, Lazio, Italy, from 01/01/2021 to 31/12/2021, 278 patients (167 M/111 F), mean age 76 (76 M/ 75 F) had previous CVD. Demographic characteristics, length of the stay (LOS) and oxygen therapy were evaluated. Results: Most common CVD pathologies were Hearth Failure (HF): 131 (72 M/59 F), Atrial Fibrillation (AF): 45 (25 M/20 F), Myocardial Infarction (MI): 26 (19 M/7 F) and associations among them. 100% of CVD COVID patients under-went Non-Invasive Ventilation (NIV) and were treated with more than 5 drugs. HF was linked with increased LOS (23 days) compared to AF (21 days), MI (18 days) and no CVD (16 days). Overall mean LOS was 16,5 days. 21,4% of total pa-tients had CVD. Conclusions: Timely identification and evaluation of patients with pre-existing CVD are fundamental for adequate treatment based on gender, severity and state of illness and for risk reduction. Keywords: polypharmacy, gender medicine; COVID 19; Sars CoV 2; cardiovas-cular disease.

Background: This study describes the attitudes and practices of Brazilian adults regarding the mandatory vaccination for COVID-19 and the hesitancy to children´s vaccination. Methods: The participants answered an online questionnaire disseminated on social networks. An adaptation of the SAGE-WG questionnaire was used to measure the children's vaccination hesitancy. Results: Among 1,007 participants, 677 (67.4%) believed that vaccination for COVID-19 among adults should be mandatory. Just over half of the participants (51.5%) believe that parents and guardians should be free to decide whether their children should be vaccinated against COVID-19, and 9.1% were unsure about this. Younger, non-religious people who have higher self-perceptions of risk for COVID-19, and who evaluate the federal government's performance in combating the disease as bad or very bad, have a higher agreement with mandatory vaccination, a lower agreement that parents and guardians should be free to vaccinate their children, and lower child vaccination hesitancy scores. Conclusion: In Brazil, mandatory COVID-19 vaccination for adults is far from a consensus, and an expressive part of the population believes that parents and guardians should be free to choose whether or not to vaccinate their children. These perceptions and vaccine hesitancy for children are associated with religious and political inclinations.

(1) Background: When the Omicron variant of SARS-CoV-2 first emerged in Germany in January 2022, data on related disease severity among children and adolescents was not yet available. Given Omicron’s high transmissibility, the ability to assess its impact on admission and hospitalization rates in children’s hospitals is critical for the purpose of understanding the scope of its burden on the German health care system. (2) Methods: From January 24, 2022 to July 31, 2022, SARS-CoV-2 cases admitted to German pediatric hospitals were monitored via a national, clinician-led reporting system (CLRS) established by the German Society for Pediatric Infectious Diseases (DGPI). Cases treated on general wards and intensive care units, as well as patient age and need for respiratory support were recorded. (3) Results: From January to July 2022, a median of 1.7 cases (range 0.4–3) per reporting pediatric hospital per day were hospitalized on general wards, whereas a median of 0.1 cases (range 0–0.4 cases) were on intensive care units. Of all hospitalized patients, 4.2% received respiratory support. (4) Conclusions: Despite the high incidence rates documented in connection with the Omicron variant in early 2022, the number of pediatric hospital admissions, and especially the number of cases with need for intensive care treatment and respiratory support due to a symptomatic SARS-CoV-2 infection, remained relatively low. Higher Omicron incidence rates had only a modest impact on SARS-CoV-2-related admissions and hospitalization in German children’s hospitals.

Background: A novel virulent coronavirus is what causes Novel Corona-virus Disease 2019 (nCOVID 19). It results in severe respiratory distress syndrome and potentially fatal infectious pneumonia. On March 12, 2020, the World Health Organization first labeled it a pandemic, which was then followed on the same day by a community health emergency of global concern. Vaccines against this deadly virus are now being created. Many drugs with different uses have been repurposed and tested for the prevention and treatment of the infection. Objective: The purpose of this review is to provide an in-depth analysis of data on possible pharmacological targets and available coronavirus treatments. Methods: Following the review protocol, a literature search was conducted. Results: Chloroquine phosphate and hydroxychloroquine, Remdesivir, and Lopinavir-Ritonavir in combination with or without interferon and convalescent plasma therapy are the main treatment candidates, according to the World Health Organization. This review article has elaborated on the current evidence of prospective pharmacological targets and related ongoing research, including inflammatory chemicals, bioactive peptides, beta cells, platelets, and the Angiotensin I Converting Enzyme 2 Receptor. This information was gathered from published journals. In addition, stories of medications and biological products like interferons and vaccinations that are utilized or could be utilized have been provided. Conclusion: There are a variety of pharmacological targets and therapeutic strategies that need more study.

Purpose: The study aimed to investigate if there were any links between liver function biomarkers and immunoglobulins levels in serum, and Toll-like receptors (TLRs) and neuropilin-1 (NRP1) in COVID-19 patients. The study also aimed to assess the accuracy—sensitivity, specificity, and area under the curve (AUC) by the receiver operator curve (ROC) analysis for immunoglobulins levels and TLRs expressions. Patients and Methods: This study included 150 patients (100 patients with confirmed COVID-19 and 50 healthy volunteers as a control group). Patients with COVID-19 were subdivided into two groups according to the severity of symptoms (moderate and severe, with 50 patients each). Serum C-reactive protein (CRP), alanine aminotransaminase (ALT), aspartate aminotransaminase (AST), albumin, lactate dehydrogenase (LDH), immunoglobulin (Ig) G, and IgM levels were estimated. TLRs (TLR2 and TLR4) and NRP1 gene expression in blood samples were investigated using quantitative real-time polymerase chain reaction (qRT-PCR). ROC analysis was also applied to determine the accuracy of various detected parameters in predicting the possibility of COVID-19 infection. Results: In COVID-19 patients, serum parameters related to liver function, except serum albumin, CRP, IgG, IgM, and TLR2, TLR4, and NRP1 mRNA expression levels, significantly elevated compared to controls. Severe COVID-19 patients exhibited significantly higher liver enzymes (ALT, AST and LDH), CRP, and TLR2 mRNA expression levels and lower albumin levels than the moderate group. In the moderate and severe groups, ALT, CRP, TLR2, and TLR4 had a significant positive correlation with IgM levels. ALT, AST, LDH, CRP, TLR2, and TLR4 showed a significant positive correlation with IgG levels in both groups. In both the moderate and severe groups, NRP1 expression was found to be significantly correlated with CRP, IgG, IgM, TLR2, and TLR4. In contrast, serum albumin levels exhibited a significant negative correlation with IgG and IgM levels only in the severe group, but they showed a significant negative correlation with TLR2, TLR4, and NRP1 expression in both moderate and severe groups. Serum ALT and AST activities were positively correlated with NRP1 expression in the moderate group but not in the severe group and as well as TLR2 and TLR4 expression in both the moderate and severe groups. ROC analysis indicated that AUC was higher than 0.800 for serum IgM level and TLR4 gene expression in moderate COVID-19 group. Conclusions: The increased liver function biomarkers in serum and NRP1 expression are closely correlated with sustained activations in humoral and innate immune responses during COVID-19 infection. As a result, TLR2, TLR4, and NRP1 could be targets for limiting COVID-19 infection and impairment effects on liver function. Moreover, detection of IgM level in serum and TLR4 expression in blood have a good accuracy in predicting the possibility of infection with COVID-19 in moderate cases.

Background: Coronavirus disease 2019 (COVID-19) remains a mystery in many respects. The importance of less common life-threatening diseases is still unclear. Therefore, in this study, it was attempted to determine the frequency of nontraumatic hemothorax, chylothorax, pleural, and pericardial effusion (PCE) in patients who underwent thoracic computed tomography during the pre-pandemic and pandemic period. Materials and Methods: This retrospective study included 147 patients over the age of 18 who were admitted to the emergency department between January 1st, 2019, and December 31st, 2020. The year 2019 was taken as the pre-pandemic period and the year 2020 was the pandemic period. Comorbidity, survival, and laboratory parameters of the patients were evaluated. Results: The mean age of the 147 patients included in the study was 66.41 ± 12.81 years, 54 (36.7%) were female, and the age range was 22–88 years. The mean plasma lactate dehydrogenase (LDH) level of the patients was 373.97 ± 115.77 U/L, plasma protein was 5.45 ± 1.00 gr/dL, fluid LDH was 229.37 ± 125.73 U/L, fluid/plasma LDH was 0.60 ± 0.23, fluid/plasma protein was 0.55 ± 0.29, and the amount of fluid discharged was 562.11 ± 243.01 mL. Bilateral lung involvement was present in 72 (49%) patients, and coagulation use was present in 59 (40.1%) patients. Pleural effusion (PE) was found in 43 (76.8%) of the hospitalized patients, hemothorax in 11 (19.6%) patients, and chylothorax in 4 (7.1%) patients. However, PCE was more common in the 16 (42.1%) patients admitted to the intensive care unit (ICU) (P < 0.001). While 38 (25.9%) of the patients were admitted to the ICU, mortality was observed in 30 (20.4%) patients. Conclusion: Although PE, nontraumatic hemothorax, chylothorax, and PCE are rare in COVID-19 patients, they can cause severe inflammation and poor prognosis.

Coronavirus disease 19 (COVID-19) continues to spread worldwide as a severe pandemic. The Omicron BA.2 became the predominant variant and the protagonist of the ongoing surge. As the virus continues to mutate, using of approved drugs or developing new therapeutic or prophylactic therapies against COVID-19 could be more complex. Sotrovimab is a monoclonal antibody (mAb) targeting the conserved epitope on the spike protein receptor; the most recent studies observed that it has substantially decreased in vitro activity against the Omicron BA.2 subvariant, but real-life data are still scarce. We describe the outcome of a case series of outpatients with BA.1 or BA.2 infection treated with sotrovimab. We conducted a retrospective observational study including all non-hospitalized adult patients treated with sotrovimab, for which a Sanger sequencing of SARS-CoV-2 was performed within a regional genomic surveillance program. Eleven (50%) patients with BA.1 infection and eleven (50%) with BA.2 infection were considered. Most patients were immunocompromised. During the follow-up period, no patient died and only one with BA.1 infection was hospitalized for severe COVID-19 pneumonia onset. One month after treatment, 90.9% of patients were completely asymptomatic in each group. We demonstrated that patients carrying the BA.2 variant treated with sotrovimab did not evolve to severe COVID-19, showing a similar outcome to BA.1 infected patients. Further studies are needed to prove that vaccination or the presumably high doses of mAbs used can protect this group of patients at high risk of progression.

We determined the levels of neutralizing antibodies against the SARS-CoV-2 ancestral strain, Delta and Omicron variants of concern (VOCs) in 125 healthcare workers, who received Coro-naVac as their primary vaccination and later received either a single ChAdOx1 or a combination of two consecutive boosters using either two ChAdOx1 doses or a ChAdOx1 or BNT162b2 as the primary and second boosters, respectively, or 2 doses of BNT162b2. The titers 12 weeks after primary vaccination were inadequate to neutralize the all strains. After a single ChAdOx1 boost-er, the levels of neutralization at Day 30 varied significantly, only a small proportion of partici-pants developing neutralizing titers against Omicron at Day 7 and 30. The two doses of ChA-dOx1 as the booster induced lowest activity. A combination ChAdOx1 and BNT162b2 induced greater neutralization than by two doses of ChAdOx1. Two doses of BNT162b2 as the booster had the maximal activity against Omicron VOC.

The COVID-19 is an exponentially growing disease that has intentioned nations to use technologies to detect the coronavirus infection. Several nations are working greatly to fight against COVID-19. Many nations have been using a range of devices to combat the pandemic, seeking information about growth, monitoring as well as the leaking the confidential information of the residents. This research aims to assist infected people online using the Internet of Things (IoT) and Blockchain technologies through smart devices. IoT-based healthcare devices gather useful information, provide additional insight through symptoms and behaviors, allow remote monitoring, and simply give people better self - determination and healthcare. Blockchain allows the secure transfer of patient health information, regulates the medical distribution network. A four-layer architecture is proposed using IoT and Blockchain to detect and prevent individuals to be COVID 19. This research provides a framework for patients with COVID-19 infectious disease and recognizes health issues and diagnoses online. Smart devices such as smartphones can install any mobile apps such as Aarogya Setu, Tawakkalna, and so on. These applications can track COVID-19 patients properly. The installation of mobile apps on smart devices focuses to reduce the time and cost and increase the performance of the infectious patient's condition. A four-layer architecture is proposed using IoT and Blockchain technologies. Many research works focus on investigating, analyzing, and highlighting the affected individuals through guiding the COVID-19 infection. Eventually, various mobile apps are recognized and addressed in this paper.

The COVID-19 pandemic has highlighted the vitalness of telehealth in our medical world, where considering a restructuring of healthcare services has become paramount. In fact, telemedicine has recently earned a valuable place in many specialties; and its implications in cardiology and cardiovascular medicine were among the leading interests. In this letter, we gathered previous evidence supporting the merit of telemedicine in the fields of cardiology and cardiovascular medicine—medical branches in which patients require meticulous care and continuous monitoring—as well as protrusions of concerns about the uncertainty regarding the efficacy of telemedicine’s future implications and technologies. In sum, in the context of this still on-going pandemic, medical institutions must strive to improve telehealth technologies and implement solid future research directions in this growing field—to be able to persevere in meeting the needs of the patients. As long as no conclusive evidence exists regarding the fields where telemedicine is most worthwhile, healthcare systems will always keep the dread of wasting resources on developing ineffective programs. We conclude that telemedicine has been attributed a considerable attention in managing cardiac and cardiovascular conditions; nevertheless, further studies with solid designs are still needed to confirm its validity and utility in those specialties.

The new SARS-CoV-2 coronavirus has brought with it an increase in the use of digital platforms and an exponential increase in the number of scientific papers worldwide. The purpose of this study is to show a global overview of the digital transformation from 1975 to the present (2021). The main collection of the Web of Science database was used to retrieve global scientific production on digital transformation. Bibliometric indicators of production, visibility, impact, and collaboration were analyzed to assess research progress on the topic. The results show that digital transformation is a construct of recent development, increasingly relevant and transdisciplinary, with a clear growth after the declaration of the global COVID-19 pandemic.

During the COVID-19 pandemic, WIC increased the Cash Value Benefit (CVB) for fruits and vegetables by roughly $25/month/person. We sought to understand WIC participant perceptions of this change and barriers and facilitators to using the CVB. We conducted 10 virtual focus groups (5 rural, 5 urban/suburban) with WIC participants (n=55) in North Carolina in March 2022. Focus groups were recorded and transcribed. We open coded the content and used thematic analysis to uncover consistencies within and between sampled groups. Participants expressed favorable perceptions of the CVB increase and stated the pre-pandemic CVB amount was insufficient. Barriers to using the increased CVB were identifying WIC approved fruits and vegetables in stores and insufficient supply of fruits and vegetables. Barriers were more pronounced in rural groups. CVB use facilitators were existing household preferences for fruits and vegetables and the variety of products that can be purchased with the CVB relative to other components of the WIC food package. Participants felt the CVB increase allowed their families to eat a wider variety of fruits and vegetables. The CVB increase may improve fruit and vegetable intake, particularly if made permanent, but barriers to CVB and WIC benefit use may be limiting the potential impact.

The development of inexpensive, fast and reliable screening tests for COVID-19 is, as yet, an unmet need. The present study was aimed at evaluating the usefulness of serum arylesterase activity of paraoxonase-1 (PON1) measurement as a screening test in patients with different severity levels of COVID-19 infection. We included 615 COVID-19 positive patients who were classified as asymptomatic, mildly symptomatic, severely symptomatic, or fatally symptomatic. Results were compared with 50 healthy volunteers, 330 patients with cancer and 343 with morbid obesity. Results showed PON1 activity greatly decreased in COVID-19 compared to healthy vol-unteers; receiver operating characteristics plot showed a high diagnostic accuracy. The degree of COVID-19 severity did not influence PON1 levels. Our results indicated that PON1 determination was efficient for disease diagnosis but not for prognosis. Further, patients with obesity or cancer presented alterations similar to those of COVID-19 patients. As such, elevated levels of PON1 in-dicate the absence of COVID-19, but low levels may be present in various other chronic diseases. The assay is fast and inexpensive. We suggest that PON1 measurement could be used as an initial, high cut-off point screening method, while lower values should be confirmed with the more ex-pensive nucleic acid amplification test.

Cardiovascular diseases (CVD´s) continue as the primary cause of death worldwide. During the past couple of years, and with the surge of the COVID-19 pandemic, deaths linked to CVD´s were -slightly overshadowed by those deaths related to COVID-19, albeit during the highest peaks of the pandemic. The present study derived form understanding the correlation between both diseases, from the standpoint of patients already diagnosed with CVD´s (n = 41883) and what comorbidities had the highest influence on overall patient death (n = 3637). Obesity, hypertension, and diabetes are all linked to worsening the outcome of COVID-19 positive patients, hence they were considered when looking at the overview of all CVD positive patients. Our finding showed that 1697 deaths were related to diabetes (p < 0.001), 987 deaths were related to obesity (p < 0.001), and lastly 2499 deaths were attributed to hypertension (p < 0.001) individually. Using logistic regression modeling, we found diabetes (OR: 1.744, p < 0.001) and hypertension (OR: 2.179, p < 0.001) had a high impact on patient deaths. Hence, having a CVD diagnosis, with hypertension and/or diabetes seems to increase the likely-hood of complication leading to death in COVID-19 positive patients.

COVID-19 outbreak started in the Chinese city of Wuhan and spread around the globe in months due to its high contagious level. Hence, this disease posed a great challenge to researchers and mathematicians. Numerous mathematical models have been suggested to visualize the spreading speed and trends of this pandemic. In this paper, a comparison of a widely established and accepted method, the Susceptible-Exposed-Infected-Quarantined-Recovered-Death-Insusceptible (SEIQRDP) model with a newly-proposed fractional-order SEIQRDP is studied. Densely populated Countries of Asia (Pakistan, India, and Bangladesh) have been chosen as data sets and both algorithms have been applied to their data. The same comparison technique has also been used on the data of two polar countries, New Zealand and Russia, that validated our findings. Error comparison of both algorithms has been recorded in a tabulated form which shows multi-fold erroneous trends over WHO data of selected countries.

The Covid-19 pandemic and the initial focus on handwashing measures have again highlighted the importance of water access as an essential service in protecting human health. Yet, especially in southern cities, uneven geographies of water access – often mediated by fragmented and unequal infrastructure systems – may hamper the fight against infectious diseases. The spread of SARS-CoV-2 presented a dilemma for water providers as well as residents in water-deprived urban areas as they had to adhere to new hygiene standards and requirements, despite limited access to basic water infrastructure. Therefore, a deeper understanding of pandemic urban waterscapes – the infrastructure and governance systems as well as everyday practices and technologies – is necessary for ongoing debates on (post-) pandemic or zoonotic cities. In our paper, we focus on changes in urban (water) governance and government water projects in Nairobi since early 2020. We show that Covid-19 has contributed to changes in Nairobi’s waterscape but only in conjunction with recent changes in the city’s overall governance structure. However, if these waterscape changes lead to greater equity in water access, and if they have helped to curb the spread of SARS-CoV-2, is more than questionable.

The COVID-19 pandemic has put a lot of pressure on health systems worldwide. Mass vaccination against SARS-CoV-2 has reduced morbidity and mortality worldwide. Despite their safety profiles, vaccines like any other medical product can cause adverse events. Yet, in countries with poor epidemiological surveillance and monitoring systems, reporting vaccine-related adverse events is scarce. The objective of this study was to describe self-reported vaccine adverse events after receiving one of the available COVID-19 vaccine schemes in Ecuador. A cross-sectional analysis based on an online self-reporting 32-questionnaire was conducted in Ecuador from April 1st to July 15th, 2021. Participants were invited by social media, radio, and TV to voluntarily participate in our study. A total of 6,654 participants were included in this study. A 38.2% of the participants reported having at least one comorbidity. Patients received AstraZeneca, Pfizer, and Sinovac vaccines, and these were distributed 38.4%, 31.1%, and 30.5%, respectively. Pain, inflammation at the injection site (20,01%), and headache (16,91%) were the most reported adverse events. Women addressed ESAVIs (64%), more often than men (36%). After receiving the first dose of any available COVID-19 vaccine, a total of 19,481 self-reported ESAVIs were informed (86.9% were mild, 11.6% moderate and 1.5% severe). In terms of vaccine type and brand, the most reactogenic vaccine was AstraZeneca with 57.8%, followed by Pfizer (24.9%) and Sinovac (17, 3 %). After the second dose, 6,757 self-reported ESAVIs were reported (87.0% mild, 10.9% moderate, and 2.1% severe). AstraZeneca vaccine users reported a higher proportion of ESAVIs (72.2%) in comparison to Pfizer/BioNTech (15.9%) and Sinovac Vaccine (11.9%). Swelling at the injection site, headache, muscle pain, and fatigue were the most common ESAVIs for the first as well as second dose. In conclusion, most ESAVIs were mild. AstraZeneca users were more likely to report adverse events. Participants without a history of COVID-19 infection, as well as those who receive the first dose, were more prone to report ESAVIs.

This study aims to comparatively analyse the importance and performance of the health of Korean and Japanese adolescents during the prolonged coronavirus disease 2019 (COVID-19) pandemic. Data were collected from 1,341 sampled Korean and Japanese adolescents in September 2021 through online and offline surveys. The collected data were analysed with frequency analysis, reliability testing, t-test, and importance-performance analysis (IPA). The following results were obtained. First, adolescents in the two countries perceive various factors about health as important during the COVID-19 pandemic, but their performance is weak compared to their perceived importance. Second, Korean adolescents had greater perceived importance for all factors of health perception compared to their Japanese counterparts. Third, the difference in performance between Korean and Japanese adolescents was especially evident for ‘hygiene management’, and there were significant differences in performance in ‘disease management’ and ‘physical activity’. Fourth, in quadrant 4 of the IPA matrix, there were similarities and differences in a particular factor of health perception between Korean and Japanese adolescents. Based on these results, we proposed measures to emphasise the importance of health and enhance performance among Korean and Japanese adolescents.

The urgency of the COVID19 pandemic caused a surge in related scientific literature. This surge made the manual exploration of scientific articles time-consuming and inefficient. Therefore, a range of exploratory search applications have been created to facilitate access to the available literature. In this survey, we give a short description of certain efforts in this direction and explore the different approaches that they used.

Nowadays, the presence of pathogen-specific antibodies in the blood is widely controlled by a serodiagnostic technique based on the lateral flow immunoassay (LFIA). However, its common one-stage format with an antigen immobilized in the binding zone of a test strip and a nanodis-persed label conjugated with immunoglobulin-binding proteins is associated with risks of very low analytical signals. It is caused by the presence of non-specific immunoglobulins in very large excess to the target antibodies in the tested samples thus decreasing their binding with the detected labels. In this study, the first stage of the immunochromatographic serodiagnosis was carried out in its traditional format using a conjugate of gold nanoparticles with staphylococcal immunoglobulin-binding protein A and an antigen immobilized on a working membrane. At the second stage, a labeled immunoglobulin-binding protein was added, which enhanced the coloration of the bound immune complexes. The use of two separated steps, binding of specific antibodies, and further coloration of the formed complexes allowed a significant reducing the influence of non-specific immunoglobulins on the assay results. The proposed approach was ap-plied for the serodiagnosis using a recombinant RBD protein of SARS-CoV-2. As a result, an in-crease in the intensity of test zone coloration by more than two orders of magnitude was demonstrated, which enabled to significantly reduce false-negative results. When testing a panel of 16 positive and 8 negative serum samples, the diagnostic sensitivity of the LFIA was 62.5% for the common format and 100% for the enhanced format; the diagnostic specificity of both variants was 100%.

Pineapple is a highly demanded fruit in international markets, thanks to its unique appearance and flavor, high fiber content, vitamins, folic acid, and minerals. It makes the pineapple production and processing market a significant source of income for producing countries, such as Costa Rica. Nowadays, its processing produces a large amount of waste with negative consequences for the environment. However, pineapple waste is an essential source of cellulose, hemicellulose, lignin, and other high-value products like enzymes (bromelain). These by-products can be obtained by pineapple waste biorefinery, generating an additional source of export goods and foreign currency, framing pineapple processing in the concept of the circular economy. This review discusses how incorporating biorefinery in the pineapple production processes can contribute to the post-COVID 19 economy in Costa Rica. Pineapple production in Costa Rica is explored, and the contamination of generated residues is delineated. Furthermore, the primary processes for by-product extraction via biorefinery, their general characteristics and applications in the medical field, and their contribution to the circular economy are presented.

Background: In the span of just two years, tracking the COVID-19 pandemic through wastewater surveillance has advanced from early reports of successful SARS-CoV-2 RNA detection in untreated wastewater to implementation of programs in at least 60 countries. Early wastewater monitoring efforts primarily originated in research laboratories and are now transitioning into more formal surveillance programs run in commercial and public health laboratories. A major challenge in this progression has been to simultaneously optimize methods and build scientific consensus while implementing surveillance programs, particularly during the rapidly changing landscape of the pandemic. Translating wastewater surveillance results for effective use by public health agencies also remains a key objective for the field. Objectives: We examine the evolution of wastewater surveillance to identify model collaborations and effective partnerships that have created rapid and sustained success. We propose needed areas of research and key roles academic researchers can play in the framework of wastewater surveillance to aid in the transition of early monitoring efforts to more formalized programs within the public health system. Discussion: Wastewater surveillance has rapidly developed as a public health tool Clinical testing programs are ramping down and home testing is on the rise, making wastewater monitoring important for future surveillance of COVID-19. Our experience in initiating and implementing wastewater surveillance programs in the United States has allowed us to reflect on key barriers and organizational challenges and draw useful lessons. As wastewater surveillance programs are formalized, the working relationships developed between academic researchers, commercial and public health laboratories, and data users should continue and should promote knowledge co-development. While wastewater surveillance has demonstrated utility for tracking COVID-19, there remain technical challenges and open scientific questions that researchers are equipped to address, which will contribute to building robust surveillance programs that provide public health practitioners with new insights into population health.

The purpose of this study was to explore the role of moral distress on physician burnout during COVID-19. Physicians in the US were interviewed between February and March 2021; 479 responded to our survey. Results indicated that moral distress was a key mediator in explaining the relationship between perceived organizational support, medical specialization, emotional labor, and coping on burnout. There was no support for increased burnout among female physicians, and contracting COVID-19 likewise did not play a role in burnout. Our findings suggest that physician burnout can be mitigated by increasing perceived organizational support; likewise, physicians who engaged in deep emotional labor and problem-focused coping tended to fare better when it came to feelings of moral distress and subsequent burnout.

The COVID-19 pandemic has highlighted the adverse consequences created by an infodemic specifically on compliance with public health guidance and vaccine uptake. COVID-19 vaccine hesitancy is a complex construct that is related to health beliefs, misinformation exposure, and perceptions of governmental institutions. This study draws on theoretical models and current data on the COVID-19 infodemic to explore the association between perceived risk of COVID-19, levels of misinformation endorsement, and opinions about the government response on vaccine uptake. We surveyed a sample of 2,697 respondents from the US, Canada, and Italy using a mobile platform between 21-28 May, 2021. Using multivariate regression, we found that country of residence, risk perception of contracting and spreading COVID-19, perception of government response and transparency, and misinformation endorsement was associated with the odds of vaccine hesitancy. Higher perceived risk was associated with lower odds of hesitancy, while lower perceptions of government response, and higher misinformation endorsement were associated with higher hesitancy.