The elderly population, who have increased susceptibility to severe outcomes, have been particularly impacted by the coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), leading to a global health crisis. However, definitive parameters or mechanisms underlying the severity of COVID-19 in elderly people remain unclear. Thus, this study seeks to elucidate the mechanism behind the increased vulnerability of elderly individuals to severe COVID-19. We employed an aged mouse model with a mouse-adapted SARS-CoV-2 strain to mimic the severe symptoms observed in elderly patients with COVID-19. Comprehensive analyses of the whole lung were performed using transcriptome and proteome sequencing, comparing data from aged and young mice. For transcriptome analysis, bulk RNA sequencing was conducted using an Illumina sequencing platform. Proteomic analysis was performed using mass spectrometry following protein extraction, digestion, and peptide labelling. We analysed the transcriptome and proteome profiles of young and aged mice and discovered that aged mice exhibited elevated baseline levels of inflammation and tissue damage repair. After SARS-CoV-2 infection, aged mice showed increased antiviral and inflammatory responses; however, these responses were weaker than those in young mice, with significant complement and coagulation cascade responses. In summary, our study demonstrates that the increased vulnerability of the elderly to severe COVID-19 may be attributed to an attenuated antiviral response and the overactivation of complement and coagulation cascades. Future research on antiviral and inflammatory responses is likely to yield treatments that reduce the severity of viral respiratory diseases in the elderly.

COVID-19 has emerged as a global health crisis with significant consequences, not only for respiratory health but also for the cardiovascular system. This study aimed to investigate potential sex-based disparities in cardiovascular outcomes among individuals diagnosed with COVID-19 A systematic search was performed in PUBMED/MEDLINE, SCOPUS, and EMBASE, up until January 2024 to identify studies measuring the sex-based differences in cardiovascular outcomes associated with COVID-19. The outcomes of interest included (myocardial infarction, venous thromboembolism, ischemic stroke, major bleeding, mortality, heart failure and hospitalization length). The meta-analysis was performed using the 'Stata' software, version 18. We identified 11 studies involving 31,044 males and 25,917 females in our review. A slightly lower risk of myocardial infarction in females (RR: 1.24; 95% CI [1.03, 1.49]; p = 0.02) contrasted with a substantially increased risk of venous thromboembolic events (RR: 1.43; 95% CI [1.19, 1.71]; p = 0.00) in males. Additionally, males displayed a slightly higher risk of major bleeding (RR: 1.22; 95% CI [1.06, 1.40]; p = 0.00). This trend continued with significantly higher rates of extracorporeal membrane oxygenation (ECMO) utilization (RR: 2.14; 95% CI [1.11, 4.13]; p = 0.02) in males. Moreover, stroke outcomes and overall mortality were demonstrably worse for males (RR: 1.46; p = 0.05 and RR: 1.21; p = 0.00, respectively). Males with COVID-19 face higher risks of myocardial infarction, venous thromboembolism, ischemic stroke, major bleeding, and mortality. Heart failure and hospitalization length show no gender disparity. These findings highlight the crucial role of gender in COVID-19's cardiovascular complications.

The sensitivity of reverse-transcription polymerase chain reaction (RT-PCR) is limited for diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Chest computed tomography (CT) is reported to have high sensitivity; however, given the limited availability of chest CT during a pandemic, the assessment of more readily available imaging, such as chest radiographs, augmented by artificial intelligence may substitute for the detection of the features of coronavirus disease 2019 (COVID-19) pneumonia.

We trained a deep convolutional neural network to detect SARS-CoV-2 pneumonia using publicly available chest radiography imaging data including 8,851 normal, 6,045 pneumonia, and 200 COVID-19 pneumonia radiographs. The entire cohort was divided into training (n = 13,586) and test groups (n = 1510). We assessed the accuracy of prediction with independent external data.

The sensitivity and positive predictive values of the assessment by artificial intelligence were 96.8% and 90.9%, respectively. In the first external validation of 204 chest radiographs among 107 patients with confirmed COVID-19, the artificial intelligence algorithm correctly identified 174 (85%) chest radiographs as COVID-19 pneumonia among 97 (91%) patients. In the second external validation with 50 immunocompromised patients with leukemia, the higher probability of the artificial intelligence assessment for COVID-19 was correlated with suggestive features of COVID-19, while the normal chest radiographs were closely correlated with the likelihood of normal chest radiographs by the artificial intelligence prediction.

The assessment method by artificial intelligence identified suspicious lung lesions on chest radiographs. This novel approach can identify patients for confirmatory chest CT before the progression of COVID-19 pneumonia.

Coronavirus disease 2019 (COVID-19) survivors are concerned about the likelihood of developing further diseases. This study examines the global trends in scientific research on diabetes associated with COVID-19 from several perspectives. Bibliometric analyses are used to undertake a scientific review of the literature. The Web of Science Core Collection (WoSCC) database was used to acquire bibliographic information on diabetes related to COVID-19 from Jan 2020 to Dec. 2023. The visual map was built via advanced CiteSpace 6.2.R6. 7,348 papers were found. Khunti Kamlesh and Rizzo-Manfredi are the most well-known high-yield authors in this area, and the top ten authors collaborate extensively. Most of these papers came from universities. Harvard Medical School has the most publications, followed by Wuhan University and Huazhong University of Science and Technology. China and the United States are the countries with the most publications. Angiotensin-converting enzymes, chronic disease, intensive care unit, viral infection, and gestational diabetes mellitus were scored 0-11, 2, 3, and 4, respectively. Zhou et al.'s work on this topic, which appeared in the prominent medical journal The Lancet, was cited 1,366 times, highlighting its importance. "clinical characteristics," "diabetes mellitus," "metabolic syndrome," and "angiotensin-converting enzyme" were used as keywords for reference co-citation and clustering data identify. Over the last four years, related investigations have focused primarily on observing clinical aspects. This report is important for developing treatment strategies, directing future research, and guiding clinical practice.

The outcome of the immune response depends on the content and magnitude of inflammatory mediators, the right time to start, and the duration of inflammatory responses. Patients with coronavirus disease 2019 (COVID-19) represent diverse disease severity. Understanding differences in immune responses in individuals with different disease severity levels can help elucidate disease mechanisms. Here, we serially analyzed the cytokine profiles of 809 patients with mild to critical COVID-19. The cytokine profile revealed an overall increase in IL-1β, IL-1Ra, TNF-α, IL-6, IL-2, IL-8, and IL-18 and impaired production of IFN-α and -β. Only an early rise in IL-1Ra, IL-6, and IL-2 levels was linked to worse disease outcomes. On the other hand, long-term rises in IL-1β, IL-1Ra, TNF-α, IL-6, IL-2, IL-8, and IL-18 levels were linked to worse disease outcomes. Principal component analysis identified a component, including IL-1β, TNF-α, IFN-α, and IL-12, that was associated with disease severity. Spearman analysis revealed that the correlation of IL-1β and IFN-α was entirely different between mild and critical patients. Therefore, the ratio of IL-1β to IFN-α seemed to be a suitable criterion for distinguishing critical patients from mild ones. The higher levels of the IL-1β to IFN-α ratio correlated with improved outcomes. These data point to an imbalance of IL-1β/IFNα, contributing to hyperinflammation in COVID-19.

Gastrointestinal (GI) manifestations have been reported as the most extra-pulmonary manifestations of coronavirus disease 2019 (COVID-19). Recognizing the various manifestations, especially as presenting symptoms of COVID-19 is of great importance. We aimed to investigate the GI and hepatic manifestations of COVID - 19 in children, determining the factors associated with the disease severity and prognosis related to GI symptoms.

In this retrospective study, children aged 1-month to 16-years who were admitted to Afzalipour Hospital in Kerman, Iran. for a period of one year (from October 2020 to October 2021) with the diagnosis of COVID-19 were included. The comparison of clinical symptoms and laboratory variables in the appendectomy and non-appendectomy groups were evaluated. Patients' information was extracted from the patient's medical record and analyzed in SPSS statistical. software.

A total of 163 patients (107 boy and 56 girls) with mean age of 4.35 ± 3.86 (range 0.08 to 16) years were included. The most frequent GI symptoms at the time of admission were watery diarrhea (46.6%), vomiting (45.4%), and abdominal pain (32.5%). There was no significant relationship between clinical symptoms and laboratory variables in the appendectomy and non-appendectomy groups, but the severity of COVID-19 was significantly associated with appendicitis (P = 0.03). There was no statistically significant relationship between liver enzyme levels and disease severity and pediatric intensive care unit admission.

Although most COVID-19 patients present with GI manifestations, we could not determine the relationship between GI and hepatic manifestations and disease severity in this study.

Not applicable.

After acute COVID-19, 5% of people experience persistent depressive symptoms and reduced cognitive function (COVID-DC). Theoretical models propose that astrogliosis is important in long COVID, but measures primarily indicative of astrogliosis have not been studied in the brain of long COVID or COVID-DC. The objective of the current study was to measure [11C]SL25.1188 total distribution volume ([11C]SL25.1188 VT), an index of monoamine oxidase B density and a marker of astrogliosis, with positron emission tomography in participants with COVID-DC and compare with healthy control participants.

In 21 COVID-DC cases and 21 healthy control participants, [11C]SL25.1188 VT was measured in the prefrontal cortex, anterior cingulate cortex, hippocampus, dorsal putamen, and ventral striatum. Depressive symptoms were measured with the Beck Depression Inventory-II, and cognitive symptoms were measured with neuropsychological tests.

[11C]SL25.1188 VT was higher in participants with COVID-DC in the prefrontal cortex, anterior cingulate cortex, hippocampus, dorsal putamen, and ventral striatum than in healthy control participants. Depressive symptom severity negatively correlated with [11C]SL25.1188 VT across prioritized brain regions. More recent acute COVID-19 positively correlated with [11C]SL25.1188 VT, reflecting higher values since predominance of the Omicron variant. Exploratory analyses found greater [11C]SL25.1188 VT in the hippocampus, dorsal putamen, and ventral striatum of COVID-DC participants than control participants with a major depressive episode with no history of COVID-19, and there was no relationship to cognitive testing in prioritized regions.

Results strongly support the presence of monoamine oxidase B-labeled astrogliosis in COVID-DC throughout the regions assessed, although the association of greater astrogliosis with fewer symptoms raises the possibility of a protective role. The magnitude of astrogliosis in COVID-DC is greater since the emergence of the Omicron variant.

This study focuses on the relationship between the faith sub-dimension of spiritual well-being and COVID-19-related fear among cancer patients. The research employs a descriptive, correlational, and cross-sectional approach to understand how faith influences psychological resilience and reduces fear in this population during the pandemic. The study was conducted with 261 cancer patients treated at a Health Application and Research Center in Turkey from March to May 2022. Data were collected using the Faith sub-dimension and the coronavirus fear scale (C19P-S). The findings reveal a significant negative relationship between Faith sub-dimension and COVID-19 fear, suggesting that Faith plays a pivotal role in enhancing psychological well-being. In line with these findings, the study recommends integrating spiritual support into the psychological care processes for cancer patients, focusing mainly on faith-based support. Recommended practical applications include spiritual counseling services provided through telemedical systems and the establishment of hospital-based spiritual care teams structured to suit cancer patients' emotional and spiritual needs.

The emergence of COVID-19 has led to a significant public health crisis, and an increase in fungal infections, including candidemia. Candida species are frequently found in intensive care units (ICUs), and it is a common cause of death in many patients. The isolates were identified using polymerase chain reaction-restriction. In this study, We investigated the factors linked to Candida infections in COVID-19 burn patients in the ICU and assessed the antifungal susceptibility of the isolates in vitro.

Out of 335 burn patients admitted to the ICU, fifty-six with concurrent COVID-19 were included in this study. A total of 133 yeast isolates were obtained from burn wounds, 29 from blood cultures, and 36 from urine cultures. The isolates were identified using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis.

Out of fifty-six patients, twenty-nine had infections and forty-eight had colonization, with Candida parapsilosis being the most common species. Twenty-one patients died during their ICU stay, with mortality rates of 43.8% among colonized patients and 69.0% among infected patients. Fluconazole and itraconazole exhibited the highest minimum inhibitory concentrations, while luliconazole and amphotericin B were identified as the most effective antifungal agents.

Our findings indicate that colonization may act as an important prognostic factor prior to the onset of candidemia. In addition, prolonged hospitalization, catheter use, and concurrent COVID-19 infection were identified as key risk factors for candidemia in this patient group. Notably, the rising drug resistance in non-albicans Candida species is a major public health concern.

This case report describes a 58-year-old woman who sought treatment in the dermatology department after experiencing a three-day episode of widespread rash and itching, along with fever, chills, abdominal distress, and increased urinary frequency and urgency. Upon examination, she exhibited numerous erythematous patches and wheals on her face and body, devoid of blisters or erosions. Laboratory tests indicated an elevated white blood cell count, C-reactive protein, and serum amyloid A, while liver and kidney function tests were within normal limits. An electrocardiogram demonstrated sinus rhythm with T-wave alterations and a V2R/S ratio greater than 1. Subsequent nucleic acid testing confirmed the presence of COVID-19 infection, prompting the initiation of anti-allergic and supportive therapies. Despite this, the patient went on to develop chest pain, which was accompanied by electrocardiographic signs of acute extensive anterior wall myocardial infarction and elevated troponin I levels. Coronary angiography subsequently revealed mild coronary artery stenosis, with no significant blockages or stenoses in the coronary arteries, leading to a diagnosis of Kounis syndrome type II. This case underscores the significance of considering Kounis syndrome in patients with a history of infection or allergies who present with chest pain, emphasizing the necessity for thorough clinical evaluation and continued research.

The objective of this study was to examine the impact of diaphragm thickness (DT) on the prognosis of elderly patients infected with COVID-19, particularly with regard to the necessity of intensive care unit (ICU) admission.

Between August 2020 and January 2021, 188 patients aged ≥ 65 years who were admitted to the internal medicine department of our hospital with a diagnosis of COVID-19 infection, were included in this study. The patients' DTs of the patients were measured by a radiologist using computed tomography (CT) scans from the right and left diaphragm dome level. DT was compared with the progression of respiratory distress and the necessity of intensive care. In statistical analysis, p < 0.05 was considered significant.

Right DT was higher in the group of patients with admission to the ICU (p = 0.11). According to multivariate logistic regression analysis, ferritin level (OR = 1; 95% CI = 1-1; p = 0.014), IL-6 level (OR = 1.004; 95% CI = 1-1.007; p = 0.045) and higher right DT (OR = 11.015; 95% CI = 3.739-32.447; p = 0.035) were found to be independent risk factors predicting the ICU admission in COVID-19 patients. There was no significant association with left DT. The predictive value of right DT for ICU requirement in COVID-19 patients was evaluated by ROC analysis. The ROC analysis showed a cut-off value > 1.8, AUC = 0.632, p = 0.009, 95% Cl (0.558-0.701). In correlation analysis, a positive correlation was found between right DT and ICU admission (r = 0.331, p < 0.001).

Our study is the first to evaluate dome-level DT with CT in elderly patients with COVID-19. In the elderly population, higher right DT levels have been observed to enhance the probability of ICU admission. This may be due to the fact that our sample group consists only of elderly people and the effects of COVID-19. We believe that further validation with more comprehensive studies is needed for DT assessment for clinical treatment decisions, particularly in COVID-19 patients. In addition, we think that the proposal for a standardized measurement site and method for DT measurement will be a guide for future studies.

Not applicable.

There are indeed several studies addressing the severity of Coronavirus disease 2019 (COVID-19) infection in myasthenia gravis (MG) patients. However, data on post-COVID-19 sequelae in MG patients remain limited. To address this gap, we collected clinical data on the condition and prognosis of MG patients with COVID-19 infection, aiming to investigate factors influencing both the severity of the infection and the occurrence of post-COVID-19 sequelae at 1 and 12 months after recovery.

This was a retrospective analysis of 150 MG patients with COVID-19 infection from November 1, 2022 to March 1, 2023 at the First Affiliated Hospital of Guangzhou University of Chinese Medicine, including patient demographics, clinical characteristics, and post-COVID-19 sequelae. Multivariable binary logistic and linear regression models were employed to ascertain the variables influencing the severity. The evolution of the post-COVID-19 sequelae was analyzed using McNemar's test.

In 150 MG patients, 128 (85.3%) patients were presented with COVID-19 infection, and 23 (18%) patients were hospitalized. The severity was associated with the daily corticosteroid dose (OR = 1.08, p = 0.02) and the frequency of myasthenia crises pre-COVID-19 (b = 7.8, t = 2.14, p = 0.035). Compared to normal patients, MG patients are more likely to experience post-COVID-19 sequelae such as insomnia, myalgia, dizziness, cough, expectoration, and sore throat at 12 months after recovery. Among these, the prevalence of myalgia, dizziness, rash, and vision impairment was significantly higher.

Compared to normal patients, MG patients are prone to developing severe COVID-19 infection, which is associated with the daily corticosteroid dose and the frequency of myasthenia crises pre-COVID-19. Additionally, they are prone to experiencing post-COVID-19 sequelae, including insomnia, myalgia, dizziness, cough, expectoration, and sore throat, at 12 months after recovery.

The use of lung ultrasound (LUS) has recently become vital in the diagnosis and prognosis of various respiratory diseases. Its role in COVID-19 requires further investigation.

Twenty-five consecutive, non-ICU hospitalized COVID-19 patients were included. LUS was performed on admission and sequentially every 3 days at 8 points in the chest. Based on the LUS findings a score was designed. Logarithmic regression models and ROC curve analysis were applied.

A statistically significant positive correlation was found between LUS score at admission and the severity of SARS-COV-2 infection. Higher LUS score was significantly associated with lower PaO2/FiO2 ratio, use of HFNC, longer hospitalization and greater extent of chest CT infiltrates. A significant association between LUS score and risk of death or intubation or HFNC was found. For one point of increase in the score, risk of death or intubation or HFNC increased 1.93-fold (95% CI 1.02 to 3.65). The predictive role of the score was very satisfactory (area under the ROC curve = 0.87).

Lung ultrasound findings were significantly positively associated with clinical and radiological markers of severity of SARS-CoV-2 pneumonia. It therefore constitutes a promising and reliable technique for assessing pneumonia, comparable to chest CT.

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to pose a significant global public health threat, particularly to older adults, pregnant women, and individuals with underlying chronic conditions. Dysregulated immune responses to SARS-CoV-2 infection are believed to contribute to the progression of COVID-19 in severe cases. Previous studies indicates that a deficiency in type I interferon (IFN-I) immunity accounts for approximately 15 %-20 % of patients with severe pneumonia caused by COVID-19, highlighting the potential therapeutic importance of modulating IFN-I signals. Natural products and their derivatives, due to their structural diversity and novel scaffolds, play a crucial role in drug discovery. Some of these natural products targeting IFN-I have demonstrated applications in infectious diseases and inflammatory conditions. However, the immunomodulatory potential of IFN-I in critical COVID-19 pneumonia and the natural compounds regulating the related signal pathway remain not fully understood. In this review, we offer a comprehensive assessment of the association between IFN-I and severe COVID-19, exploring its mechanisms and integrating information on natural compounds effective for IFN-I regulation. Focusing on the primary targets of IFN-I, we also summarize the regulatory mechanisms of natural products, their impact on IFNs, and their therapeutic roles in viral infections. Collectively, by synthesizing these findings, our goal is to provide a valuable reference for future research and to inspire innovative treatment strategies for COVID-19.

The birth process involves biopsychosocial aspects, the identification of which has been little researched. This systematic review aims to identify biopsychosocial aspects of interventions during physiological birth in first-time mothers and to assess the effectiveness of these interventions on birth outcomes.A systematic guideline search resulted in the definition of a physiological birth of first-time mothers with a singleton from the cephalic position at 37+0 to 42+0 weeks' gestation. A systematic literature search assessed intervention studies for evidence quality using the GRADE methodology. Structured content analysis according to Mayring was used to identify biopsychosocial aspects.18 bio-organic, psychological and sociological aspects were identified from 20 studies. The quality of evidence was mostly low to very low due to inadequate reporting of fetal and maternal outcomes and characteristics. Moderate confidence was shown for midwifery care and aromatherapy in increasing spontaneous labor, and transcutaneous electrical nerve stimulation in improving satisfaction, subjective pain perception and APGAR score. Identified biopsychosocial aspects enable a multidimensional assessment of physiological birth and could lead to a biopsychosocial care model. Insufficient quality of evidence does not allow the derivation of specific interventions. Studies in obstetrics should use defined endpoints and characteristics to improve the quality of evidence.

The COVID-19 pandemic has raised concerns about nursing home (NH) residents' well-being, with recent studies indicating a significant increase in functional decline rate during this critical period. However, a comprehensive exploration of functional capacity trajectories in NH residents during the pandemic remains unexplored. This study aims to address this research gap by conducting an in-depth analysis of the impact of the COVID-19 pandemic on NH residents' functional capacity.

A 24-month multicenter prospective study involving 123 NH residents from Spain, with data collected at 6-month intervals over 5 waves, starting just before the pandemic's onset. Functional capacity was assessed using the Modified Barthel Index, and data were analyzed employing the actuarial method, log-rank test, and Cox's regression.

The likelihood of maintaining functional capacity was unfavorable, with only a 19.3% chance of preservation for a 1-point decline (FD-1) in Barthel scores and a 50.5% probability for a 10-point decline (FD-10). Personal hygiene, eating, and toilet use were identified as the most affected activities of daily living. Urinary continence decline emerged as a risk factor for FD-1, while fecal continence decline was associated with FD-10. The probability of maintaining functional capacity in the initial 6 months of a pandemic was comparable to a 2-year non-pandemic follow-up. Pandemic-induced isolation strategies significantly impacted toileting and personal hygiene. Urinary decline was associated with minor functional decline (FD-1), while fecal decline correlated with major functional decline (FD-10). Notably, the number of days spent in room confinement did not significantly contribute to the observed decline.

A substantial increase in the risk of FD among NH residents during the COVID-19 pandemic compared to the pre-pandemic period was found. It is crucial to implement urgent, targeted interventions that prioritize promoting physical activity and the implementation of mobility and toileting programs. These measures are pivotal for mitigating functional decline and enhancing the overall health and well-being of NH residents in a pandemic context.

The outbreak of COVID-19 pandemic has caused substantial health loss worldwide, and the long-term sequelae of COVID, resulting from repeated coronavirus infection, have emerged as a new public health concern. We report the widespread presence of abnormal metallomic profiles in the sera of patients who have recovered from SARS-CoV-2 coronavirus infection, even after 6 months post-discharge from hospital. We measured the concentrations of Fe, Cu, Zn, Se, Cr, Mn, Ba, Ni, Pb, Ag, As, Cd, Co, and V in the sera of 25 recovered participants and 38 healthy controls in the cross-sectional study. Higher concentrations of Cu, Ag, As, Ba, Cd, Ni, Pb, Cr and V were observed in the recovered participants, whereas lower concentrations of Fe and Se were obtained in these participants. Except for Zn, Mn, and Co, all other elements showed significant differences (p < 0.05) between the two groups, with variations dependent on age and gender. Further correlation analysis between metallome and metabolome indicated that SARS-CoV-2 infection continues to disrupt metallic homeostasis and affect metabolic processes, such as lipid metabolism and cell respiration, as well as the functions of certain organs (e.g., liver, kidney, and heart), even after 6 months recovery. Our findings provide novel insights into the potential long-term effect of COVID-19 on the human body from a new perspective of metallomics.

The mechanisms by which severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes severe lung inflammation and mortality remain unclear. While the role of alveolar macrophages in COVID-19 is known, data on pulmonary intravascular macrophages (PIMs) is lacking. PIMs are key inflammatory cells present in species like cattle and pigs. Though constitutively absent in humans and rodents, their recruitment in rodents triggers exaggerated inflammation. We investigated the recruitment of PIMs and other immune cells, using immunofluorescence, hematoxylin and eosin (H&E) staining, and immunogold labeling in a hamster model of SARS-CoV-2 infection. Syrian golden hamsters were divided into 6 groups: uninfected control, unvaccinated-infected at 2-, 5-, and 14-days post infection (dpi) and vaccinated-infected at 5- and 14-dpi. Lung tissues were analyzed for neutrophils (myeloperoxidase), monocytes/macrophages (CCR2, CX3CR1), macrophages (IBA-1), and T cells (CD3). Septal macrophages increased at 2-, 5-, and 14-dpi in infected animals vs. control. CX3CR1 + cells decreased at 14-dpi in unvaccinated animals, but CX3CR1/CCR2 double positive cells were higher at 5-dpi, indicating a pro-inflammatory macrophage phenotype. PIMs were confirmed by transmission electron microscopy. These are the first data showing recruitment of pro-inflammatory PIMs in SARS-CoV-2 infected lungs.

Therapeutic plasma exchange (TPE) is the primary intervention for treating symptomatic hyperviscosity from hypergammaglobulinemia, yet its efficacy for treating hyperviscosity related to hyperfibrinogenemia is unclear.

Define the safety and efficacy of TPE for critically ill COVID-19 patients with elevated blood viscosity from hyperfibrinogenemia.

We performed a prospective randomized controlled trial in critically ill COVID-19 patients in a single US healthcare system. Patients with hyperfibrinogenemia (>800 mg/dL) or elevated plasma viscosity (2.3-3.5 centipoise [cP]) were randomized to receive TPE on 2 consecutive days or continued standard of care (SOC).

Twenty participants were enrolled, with 10 receiving TPE and 10 receiving SOC alone. Mean (±SEM) plasma viscosity decreased significantly from 2.35 cP (±0.12) to 1.61 cP (±0.03) in the TPE group and was unchanged in the SOC group (2.47 cP [±0.11] to 2.47 cP [±0.15]). Mean fibrinogen decreased from 934.0 mg/dL (±25.1) to 359.1 mg/dL (±22.5) after TPE vs from 859.6 mg/dL (±57.6) to 807.3 mg/dL (±63.1) in SOC. There was no significant difference in 28-day all-cause mortality between groups, with 2 deaths in the TPE cohort and 5 deaths in the SOC cohort (P = .13). No serious safety events related to TPE were reported. TPE significantly decreased biomarkers of inflammation (erythrocyte sedimentation rate and C-reactive protein) and endothelial activation (von Willebrand factor and factor VIII) but not hemostatic activation (prothrombin fragment 1.2, thrombin-antithrombin complex, and fibrin monomer) or immunoglobulin (IgG and IgM) levels.

TPE is safe and effective for normalizing elevated blood viscosity from hyperfibrinogenemia in COVID-19 patients. Additional studies are needed to determine the impact of TPE on overall patient outcomes, including in those with non-COVID-19 conditions associated with hyperfibrinogenemia.

AimThe goal of this study was to identify changes in cognitive and functional capacity after hospital discharge in those infected with COVID-19 who were admitted to the ICU.MethodsThis is a prospective cohort study carried out with individuals who were admitted to a hospital, from July 2021 to May 2022. The evaluations happened in three moments: at hospital discharge, 30 days after discharge and 90 days after discharge. The instruments applied are the following: handgrip dynamometer, Montreal Cognitive Assessment Basic questionnaire (MoCA-B), Barthel Index (BI), timed up and go test (TUG), hospital anxiety and depressive scale (HADS) and 36-Item Short Form Health Survey questionary (SF-36).Results74 individuals were eligible to participate in the study, 25 of which were followed for 90 days. Based on the results of the MoCA-b, there were no relevant cognitive changes after 3 months. According to the Barthel Index applied to each of the evaluations, the percentage of subjects that were classified as independent or minimally dependent was 48%, 92% then 96%, respectively, demonstrating that individuals can achieve a good degree of functional independence after 3 months. Despite that, the SF-36 demonstrated a score below the South Brazilian normal in some domains.ConclusionThe individuals studied did not present persistent cognitive changes after 3 months and functional capacity showed significant improvement during this period. However, when the assessment is about the self-perceived quality of life, the majority of domain values are still below expectations, deserving attention by the health professionals involved.

The death rate of hematological malignancies is high, and the death rate of patients with COVID-19 infection is further increased. Although there have been expert consensus and relevant guidelines to introduce the recommendations of the guidelines for patients with hematological malignancies complicated with COVID-19 infection, there is limited understanding of the clinical characteristics of Chinese patients with acute leukemia complicated with COVID-19 infection.

This study aimed to analyze the clinical manifestations, mortality, and determinants of viral shedding duration in Chinese AL patients infected with COVID-19.

We conducted a retrospective study of 100 AL patients with COVID-19 infection in Henan Province, China, from December 1, 2022, to January 31, 2023. Data on demographics, leukemia subtype, symptoms, treatments (antibiotics/antivirals), and viral shedding duration were collected. Follow-up was conducted over three months to assess mortality. Univariate and multivariate analyses were performed to identify risk factors.

The median age was 49.5 years (58% male, 42% female), with 76% having acute myeloid leukemia (AML) and 24% acute lymphoblastic leukemia (ALL). Most patients (86%) were asymptomatic. Antibiotics and antivirals were administered to 35% and 25% of patients, respectively. Severe cases and fatalities exhibited prolonged viral shedding. Neutropenic patients on antibiotics had significantly extended shedding duration, whereas antiviral therapy or delayed primary disease management shortened it. The overall mortality rate was 6%. Univariate analysis identified neutropenia as a key mortality risk factor, though multivariate analysis showed no significant associations.

Early antiviral treatment may reduce viral shedding duration and potentially mitigate symptom severity and mortality in AL patients with COVID-19. Neutropenia emerged as a critical factor influencing outcomes. These findings underscore the importance of tailored therapeutic strategies for this high-risk population.

This study aimed to determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on the treatment of acute cholangitis caused by choledocholithiasis.

The Japanese government declared a state of emergency in April 2020 due to the COVID-19 pandemic. We retrospectively reviewed the medical records of 309 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for acute cholangitis caused by choledocholithiasis between April 2017 and December 2022.

Patients were categorized into a pregroup (n = 134) and a postgroup (n = 175), depending on whether they were diagnosed before or after the state of emergency declaration. The total number of ERCP cases and the number of ERCP cases with endoscopic stone removals increased after the state of emergency declaration. Compared with the pregroup, the numbers of patients with performance status of 0-1 and surgically altered anatomy increased, whereas the numbers of patients taking oral antiplatelets or anticoagulants and those with cerebrovascular disease decreased in the postgroup. The number of single-stage endoscopic stone removals increased and hospital stays were significantly shorter in the postgroup. No differences in adverse event rates were detected between the two groups.

Although our hospital provides tertiary care, the number of patients with cholangitis in good general condition and no underlying disease increased after the state of emergency declaration. The COVID-19 pandemic resulted in an increase in the number of single-stage endoscopic treatments and shortened hospital stays for patients with acute cholangitis caused by choledocholithiasis. No safety issues with ERCP were detected, even during the pandemic.

Immunomodulators tocilizumab and baricitinib have been used for the treatment of severe COVID-19, however, there are only few published studies comparing their efficacy.

All consecutive non-ICU hospitalized severe COVID-19 patients who received baricitinib or tocilizumab, were included retrospectively. Primary outcomes were mortality or intubation on day 14, time to oxygen therapy weaning and duration of hospitalization. Safety was measured as treatment-related adverse events.

321 hospitalized patients with severe COVID-19 were included (mean age 62.4 years ± 14.7); 241 (75.1%) received baricitinib (mean age 64.2 years ± 15.2) and 80 (24.9%) tocilizumab (mean age 57.3 ± 11.7). Patients who received baricitinib presented significantly lower risk of mortality or intubation on day 14, compared to the tocilizumab group after adjusting for age, sex, vaccination, Charlson comorbidity index, body mass index, remdesivir administration and WHO ordinal scale at enrollment (OR: 0.42, 95% CI: 0.20-0.86). In the augmented inverse-probability weighting regression, the protective role of baricitinib remained statistically significant (OR: 0.76, 95% CI: 0.66-0.88). No difference in secondary bacterial infections was detected, but tocilizumab was associated with significant higher rate of liver injury (Odds Ratio, 95%CI, p < 0.001).

Our study suggests survival and safety are significantly better for baricitinib compared to tocilizumab in severe COVID-19. Clinical randomized trials are needed for confirmation.

Patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) who require surgical procedures are likely to experience higher postoperative mortality and morbidity. Our objective was to evaluate the perioperative course of patients infected with SARS-COV-2 undergoing surgical procedures. The purpose of this study was to describe the characteristics, outcomes, and the effect of the presence of symptoms.

Retrospective cohort.

We analyzed the records of patients with SARS-CoV-2 infection who underwent surgical procedures from March 2020 to March 2021. Patients with ongoing infection at the time of surgery and those who had recently recovered were included. The primary outcome measure was 30-day in-hospital mortality after surgery. Secondary outcomes were intensive care unit (ICU) admission, length of stay in ICU, postoperative length of stay, and complications.

Data from 102 patients were analyzed. Twenty-four patients (23.5%) died postoperatively in the hospital within 30 days. Forty-four patients required ICU admission (average stay 13 days). The median postoperative length of stay was 8 days (interquartile range, 3.75 to 19.25 days). Pulmonary, thromboembolic, and surgical complications were noted in 29 (28.4%), 14 (13.7%), and 18 (17.6%), respectively. Patients aged 41 to 60 years experienced higher rates of pulmonary and thromboembolic complications. Comparison of asymptomatic versus symptomatic patients revealed significantly higher 30-day in-hospital mortality (9 [15%] vs 15 [35.7%], P = .019), ICU admission (17 [28.3%] vs 27 [64.3%], P < .001), length of stay in ICU (3 [2 to 11.5] vs 18 [7 to 27], P = .001), postoperative length of stay (6 [3 to 10.75] vs 12 [5 to 25.25], P = .016) and pulmonary complication rates (11 [18.3%] vs 18 [42.9%], P = .008) in the symptomatic patients.

Symptomatic SARS-COV-2 patients undergoing surgical procedures experience significantly higher 30-day in-hospital mortality, ICU admission, longer ICU and hospital stay, and pulmonary complications.

To develop an instrument for assessing competence in emerging infectious disease prevention among health and care workers in long-term care institutions and evaluate its psychometric properties.

A cross-sectional, descriptive design utilising both qualitative and quantitative methods was employed.

Based on scale development guidelines, the scale was developed in two phases, namely the scale development phase and scale testing phase, with the staff of long-term care institutions as the study population and their workplaces as the sampling unit.

The scale comprises 27 items across three dimensions: 14 items pertaining to professional role performance, 7 items addressing workplace resources, and 6 items focusing on soft skills in communication and collaboration. Content analysis was conducted via a focus group discussion; content validity analysis was carried out via expert reviews; item analysis was performed via a pilot study; and construct validity and reliability were ensured via factor analysis and internal consistency testing, respectively. The total variance explained by the three factors of the 27-item scale was 64.8%, demonstrating acceptable validity and reliability with a Cronbach's α value of 0.97.

This scale demonstrates excellent reliability and validity, making it suitable for clinical practice and research. In practice, this instrument could also assist managers in adjusting policies to adapt to dynamic situations and enhance the quality of care in long-term care institutions. Nonetheless, further research is warranted to refine the scale and enhance its generalisability.

The scale is a psychometrically robust tool tailored for the evaluation of competence in emerging infectious disease prevention in long-term care institutions. It assesses the role performance, workplace resources, and soft skills of health and care workers in these institutions, which are crucial for guiding educational interventions and shaping policies to enhance disease prevention, ultimately improving care quality.

No patient or public contribution.

The impacts of COVID-19 on acute myocardial infarction (AMI) care were heterogeneous. The study aims to analyze the clinical characteristics and outcomes of AMI patients in China during different stages of the COVID-19 pandemic.

This is a multicenter retrospective cohort study in Shanxi Province of northern China. Patients diagnosed with AMI during the zero-case, lockdown, and outbreak periods were included. Characteristics and outcomes were analyzed according to time periods and COVID-19 infection. The primary outcome was in-hospital mortality. Additional outcomes included reperfusion times, coronary angiographic measures, procedure or AMI-associated complications, arrhythmia, other adverse events, and left ventricular systolic dysfunction (LVSD).

The study included 1021 AMI patients, with 393, 250, and 378 from the zero-case, lockdown, and outbreak periods. No differences in in-hospital mortality or other adverse events were found by time periods. By infection status, 264 patients were COVID-positive, and 706 were COVID-negative. The COVID-positive ST-elevation myocardial infarction population had longer symptom-to-first medical contact (3.07 vs. 2.31, p = 0.026), pre-hospital time (4.58 vs. 3.67, p = 0.032), door-to-balloon (1.20 vs. 1.08, p = 0.046), and total ischemic time (5.80 vs. 4.70, p = 0.011). No differences in other in-hospital outcomes were found, except that multivariate logistic regression analysis demonstrated COVID-19 infection was correlated with increased risks of LVSD (OR 1.73, 95% CI 1.11-2.69, p = 0.015).

In-hospital mortality did not differ by time period or COVID-19 infection status. The COVID-positive AMI patients had longer reperfusion times and higher risks of LVSD. AMI treatments were impacted during the pandemic, and measures are warranted to minimize the reperfusion time.

Zinc plays an important role in the functioning of the immune system. Zinc deficiency leads to increased susceptibility to inflammatory and infectious diseases. There are few studies investigating the role of zinc in the development and progression of COVID-19 in children, and their findings remain inconsistent. This study aimed to determine the zinc levels in children with COVID-19 and assess their association with symptoms, inflammation markers, and disease progression.

A prospective cohort study included hospitalized patients under 18 years who had a confirmed diagnosis of SARS-CoV-2 infection. Serum zinc concentrations were measured using a colorimetric method. Based on zinc levels, the children were divided into two groups: the first group had concentrations below 10.7 μmol/L, indicating zinc deficiency, while the second group had levels above 10.7 μmol/L, which was considered within the optimal range.

In total, 140 hospitalized patients with COVID-19 were examined. Zinc deficiency was identified in 40 children (28.6%), while optimal levels were found in 100 children (71.4%). Zinc status did not depend on the age of the children. Among the symptoms of acute SARS-CoV-2 infection, children with zinc deficiency showed a trend toward more frequent fever occurrences (p = 0.0654). No significant impact of zinc status was observed on the severity of COVID-19 or the duration of hospitalization. Children with zinc deficiency had higher median values of the neutrophil-to-lymphocyte ratio (NLR) (1.84 vs. 1.09, p = 0.0010), C-reactive protein (CRP) levels (9.65 vs. 3.96 mg/L, p = 0.0053), and fibrinogen levels (2.88 vs. 2.07 g/L, p = 0.0057) compared to those with adequate zinc levels. Additionally, the percentage of patients with a NLR greater than 4, elevated CRP, and fibrinogen levels was higher in the zinc-deficient group (p = 0.0017, p = 0.0107, p = 0.0338, respectively).

Zinc deficiency was observed in 28.6% of children with COVID-19 and was not dependent on age. Children with hypozincemia had higher levels of inflammation markers, including the neutrophil-to-lymphocyte ratio and CRP.

Coronavirus disease 2019 (COVID-19) is a newly emerged infectious disease that needs further clinical investigation. Characterizing the temporal pattern of combined infections in patients with COVID-19 may help clinicians understand the clinical nature of this disease and provide valuable diagnostic and therapeutic guidelines.

We retrospectively analyzed COVID-19 patients isolated in four study hospitals in Korea for one year period from May 2021 to April 2022 when the delta and omicron variants were dominant. The temporal characteristics of combined infections based on specific diagnostic tests were analyzed.

A total of 16,967 COVID-19 patients were screened, 2,432 (14.3%) of whom underwent diagnostic microbiologic tests according to the clinical decision-making, 195 of whom had positive test results, and 0.55% (94/16,967) of whom were ultimately considered to have clinically meaningful combined infections. The median duration for the diagnosis of combined infections was 15 (interquartile range [IQR], 5-25) days after admission. The proportion of community-acquired coinfections (≤ 2 days after admission) was 11.7% (11/94), which included bacteremia (10/94, 10.63%) and tuberculosis (1/94, 1.06%). Combined infections after 2 days of admission were diagnosed at median 16 (IQR, 9-26) days, and included bacteremia (72.3%), fungemia (19.3%), cytomegalovirus (CMV) diseases (8.4%), Pneumocystis jerovecii pneumonia (PJP, 8.4%) and invasive pulmonary aspergillosis (IPA, 4.8%).

Among COVID-19 patients with risk factors for severe complications, 0.55% had laboratory-confirmed combined infections, which included community and nosocomial pathogens in addition to unusual pathogens such as CMV disease, PJP and IPA.

Overview: SARS CoV-2 infection is accompanied by the development of acute inflammation, resolution of which determines the course of infection and its outcome. If not resolved (brought back to preinjury status), the inflamed state progresses to a severe clinical presentation characterized by uncontrolled cytokine release, systemic inflammation, and in some death. In severe CoV-2 disease, the required balance between protective inflammation and its resolution appears missing, suggesting that the ω-3-derived specialized proresolving mediators (SPMs) needed for resolution are either not present or present at ineffective levels compared to competing ω-6 polyunsaturated fatty acid (PUFA) metabolic derivatives. Aim: To determine whether ω-6 PUFA linoleic acid (LA) metabolites increased in those infected with severe disease compared to uninfected controls. Findings: Increased levels of ω-6 LA metabolites, e.g., arachidonic acid (AA), epoxyeicosatrienoic (EET) acid derivatives of AA (8,9-, 11,12-, and 14,15-EETs), AA-derived hydroxyeicosatetraenoic (HETE) acid, dihydroxylated diols (leukotoxin and isoleukotoxin), and prostaglandin E2 with decreased levels of ω-3-derived inflammation resolving SPMs. Therapeutic treatment of SARS CoV-2 patients with ω-3 PUFA significantly increased 18-HEPE (SPM precursor) and EPA-derived diols (11,12- and 14,15-diHETE), while toxic 9,10- and 12,13-diHOMEs (leukotoxin and iosleukotoxin, respectively) decreased. Conclusion: Unbalanced dietary intake of ω-6/ω-3 PUFAs contributed to SARS CoV-2 disease severity by decreasing ω-3-dependent SPM resolution of inflammation and increasing membrane-associated ferroptotic AA peroxidation.

Identifying patients at a risk of severe COVID-19 is crucial for prompt intervention and mortality risk mitigation. The monocyte distribution width (MDW) is an effective accurate predictor of sepsis in emergency settings, facilitating timely patient management. However, few reliable laboratory parameters are available for predicting the severity and prognosis of COVID-19. Thus, this study was conducted to investigate whether MDW can accurately predict the severity and progression of COVID-19 pneumonia.

This retrospective cohort study included patients with COVID-19 pneumonia who had been admitted to our hospital between January 1, 2022, and September 31, 2022. The primary outcome was the development of critical illness, which was assessed in terms of intensive care unit (ICU) admission, need for mechanical ventilation (MV), or mortality. The secondary outcomes were durations of ICU stay, MV, and hospital stay. Multivariate logistic regression was performed to estimate the risks of critical illness and mortality.

Data from 878 patients with COVID-19 were analyzed. Of these, 258 (29.4%) developed critical illness. The high-MDW group (MDW > 22) showed a higher rate of critical illness (155/452, 34.29%) compared to the low-MDW group (103/426, 24.18%). Mortality was also higher in the high-MDW group (95/452, 21.02%) than in the low-MDW group (37/426, 8.69%). Patients with MDW > 22 exhibited a significantly higher risk of developing critical illness (adjusted odds ratio [aOR]: 1.48; 95% confidence interval [CI]: 1.08-2.04) and mortality (aOR: 2.46; 95% CI: 1.63-3.74) compared to those with MDW ≤ 22.

Our findings suggest that an elevated MDW value at presentation may serve as a promising predictor of severe outcomes in patients with COVID-19 pneumonia. This underscores the need for further research to validate the utility of MDW in predicting critical illness among patients with viral pneumonia.

N-acetylcysteine (NAC) can take part in the treatment of chronic respiratory diseases because of the potent mucolytic, antioxidant, and anti-inflammatory effects of NAC. However, less is known about its use in the treatment of acute lung injury. Nowadays, an increasing number of studies indicates that early administration of NAC may reduce markers of oxidative stress and alleviate inflammation in animal models of acute lung injury (ALI) and in patients suffering from distinct forms of acute respiratory distress syndrome (ARDS) or pulmonary infections including community-acquired pneumonia or Coronavirus Disease (COVID)-19. Besides low costs, easy accessibility, low toxicity, and rare side effects, NAC can also be combined with other drugs. This article provides a review of knowledge on the mechanisms of inflammation and oxidative stress in various forms of ALI/ARDS and critically discusses experience with the use of NAC in these disorders. For preparing the review, articles published in the English language from the PubMed database were used.

Infection with SARS-CoV-2, the virus responsible for COVID-19, can lead to a range of physical symptoms and mental health challenges, including stress, anxiety, and depression. These effects are particularly pronounced in hospitalized patients, likely due to the virus's direct and indirect impact on the nervous system. Gut dysbiosis, an imbalance in the gut microbiome, has been implicated in immune dysfunction and chronic inflammation in COVID-19 patients. However, the interactions between gut microbiome composition and the physical and mental symptoms of COVID-19 remain incompletely understood.

We investigated the association between physical and mental symptoms, cytokine profiles, and gut microbiota composition in 124 hospitalized COVID-19 patients. We collected data on demographics, COVID-19 severity, and mental health indicators (stress, anxiety, and depression). Gut microbiome profiling was performed using full-length 16 S rRNA gene sequencing to evaluate microbial diversity and composition.

COVID-19 severity was categorized as low (27.4%), moderate (29.8%), or critical (42.8%). Common symptoms included fever (66.1%) and cough (55.6%), while somatic symptoms (27.3%), anxiety (27.3%), depressive symptoms (39%), and stress (80.5%) were frequently self-reported. Elevated interleukin-6 levels in severe cases highlighted systemic inflammation, reduced gut bacterial diversity, particularly among women and obese patients, correlated with higher disease severity. Notably, the genus Mitsuokella was associated with increased physical symptoms and mental distress, while Granulicatella was linked to critical illness.

Our findings reveal significant associations between mental health status, systemic inflammation, and gut dysbiosis in hospitalized COVID-19 patients. These results indicate the potential for microbiome-targeted therapies to mitigate psychological and physical complications and improve recovery outcomes in this population.

High-density lipoproteins (HDLs) are heterogeneous particles with pleiotropic functions including anti-inflammatory and anti-infectious effects. In clinical studies, lower HDL-associated cholesterol (HDL-C) concentration has been associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, severity and mortality. A reduction in the number of HDL particles, particularly small ones has been observed with alterations in their protein and lipid composition impairing their functions. These observations have supported HDL supplementation with promising results in small preliminary studies. This review summarizes available evidence on these different aspects to better understand the two-way interaction between HDLs and Coronavirus disease 2019 (COVID-19) and guiding future HDL-based therapies for preparing the next pandemic.

This systematic review evaluates the efficacy and safety of COVID-19 vaccines in individuals with cystic fibrosis (CF). A systematic search of major databases conducted between December 2019 and January 2024 identified eight cohort studies comprising 1,361 CF patients. Studies without subgroup analyses specific to CF patients were excluded, which may have limited the generalizability of findings, particularly for CF lung transplant recipients. COVID-19 vaccines generally induced robust serological responses following the second and third doses, although reduced antibody levels were observed in lung transplant recipients. Factors influencing humoral response included prior SARS-CoV-2 infection, age, inhaled corticosteroid use, and immunosuppressive therapy. Vaccination-related adverse events were predominantly mild. Although breakthrough infections were reported, severe COVID-19 outcomes were infrequent among vaccinated CF patients. The evidence supports the immunogenicity and safety of COVID-19 vaccines in the CF patients. However, individualized vaccination strategies may be necessary for CF lung transplant recipients and those on immunosuppressive therapies. Further research is essential to optimize vaccination strategies and to identify risk factors associated with breakthrough infections in this high-risk population.