47 ud af 47 tidsskrifter valgt, søgeord (COVID-19, SARS-CoV-2, novel coronavirus, nCoV, 2019-nCoV) valgt, emner højest 30 dage gamle, sorteret efter nyeste først.
208 emner vises.
1
Anti-Spike monoclonal antibody monotherapies and immune escape risk minimization strategies
Clinical Infectious Diseases, 13.05.2024
Tilføjet 13.05.2024
2
Assessment of the Impact of RNase in Patients With Severe Fatigue Related to Post-Acute Sequelae of SARS-CoV-2 Infection (PASC): A Randomized Phase 2 Trial of RSLV-132
Clinical Infectious Diseases, 12.05.2024
Tilføjet 12.05.2024
Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA and RNA debris persist in viral reservoirs for weeks to months following infection, potentially triggering interferon production and chronic inflammation. RSLV-132 is a biologic drug composed of catalytically active human RNase1 fused to human IgG1 Fc and is designed to remain in circulation and digest extracellular RNA. We hypothesized that removal of SARS-CoV-2 viral RNA from latent reservoirs may improve inflammation, neuroinflammation, and fatigue associated with post-acute sequelae of SARS-CoV-2 infection (PASC).Methods This was a phase 2, double-blind, placebo-controlled randomized clinical trial in participants with a 24-week history of PASC and severe fatigue. The primary endpoint of the trial assessed the impact of 6 intravenous doses of RSLV-132 on the mean change from baseline at day 71 in the Patient-Reported Outcomes Measurement Information System Fatigue Short Form 7a (PROMIS Fatigue SF 7a).Results A statistically significant difference on day 71 was not observed with respect to the primary or secondary endpoints. This was likely due to a placebo response that increased during the trial. Statistically significant improvement in fatigue as measured by the PROMIS Fatigue SF 7a, Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-Fatigue), and Physicians Global Assessment (PGA) instruments were observed earlier in the trial, with women demonstrating greater responses to RSLV-132 than men.Conclusion While fatigue was not statistically significantly improved at Day 71, earlier timepoints revealed statistically significant improvement in fatigue and physician global assessment. The data suggest eliminating latent viral RNA by increasing serum RNase activity may improve fatigue in PASC patients. Women may respond better to this approach than men. Future studies will aim to confirm these findings.
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3
A systematic review of thromboembolic complications and outcomes in hospitalised COVID-19 patients
BMC Infectious Diseases, 11.05.2024
Tilføjet 11.05.2024
Abstract Thromboembolic (TE) complications [myocardial infarction (MI), stroke, deep vein thrombosis (DVT), and pulmonary embolism (PE)] are common causes of mortality in hospitalised COVID-19 patients. Therefore, this review was undertaken to explore the incidence of TE complications and mortality associated with TE complications in hospitalised COVID-19 patients from different studies. A literature search was performed using ScienceDirect and PubMed databases using the MeSH term search strategy of “COVID-19”, “thromboembolic complication”, “venous thromboembolism”, “arterial thromboembolism”, “deep vein thrombosis”, “pulmonary embolism”, “myocardial infarction”, “stroke”, and “mortality”. There were 33 studies included in this review. Studies have revealed that COVID-19 patients tend to develop venous thromboembolism (PE:1.0-40.0% and DVT:0.4-84%) compared to arterial thromboembolism (stroke:0.5-15.2% and MI:0.8-8.7%). Lastly, the all-cause mortality of COVID-19 patients ranged from 4.8 to 63%, whereas the incidence of mortality associated with TE complications was between 5% and 48%. A wide range of incidences of TE complications and mortality associated with TE complications can be seen among hospitalized COVID-19 patients. Therefore, every patient should be assessed for the risk of thromboembolic complications and provided with an appropriate thromboprophylaxis management plan tailored to their individual needs.
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4
Neutrophil Extracellular Traps (NETs): An Emerging Therapeutic Target to Improve Infectious Diseases Outcomes
Journal of Infectious Diseases, 11.05.2024
Tilføjet 11.05.2024
Abstract Neutrophils possess a diverse repertoire of pathogen clearance mechanisms, one of which is the formation of neutrophil extracellular traps (NETs). NETs are complexes of histone proteins and DNA coated with proteolytic enzymes that are released extracellularly to entrap pathogens and aid in their clearance, in a process known as NETosis. Intravascular NETosis may drive a massive inflammatory response that has been shown to contribute to morbidity and mortality in many infectious diseases, including malaria, dengue fever, influenza, bacterial sepsis, and SARS-CoV-2 infection.In this review we seek to: (1) summarize the current understanding of NETs; (2) discuss infectious diseases in which NET formation contributes to morbidity and mortality; and (3) explore potential adjunctive therapeutics that may be considered for future study in treating severe infections driven by NET pathophysiology. This includes drugs specifically targeting NET inhibition and FDA-approved drugs that may be repurposed as NET inhibitors.
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5
Factors affecting the number of influenza patients before and during COVID-19 pandemic, Thailand
Oiythip Yasopa, Nontiya Homkham, Pornthip Chompook
PLoS One Infectious Diseases, 11.05.2024
Tilføjet 11.05.2024
by Oiythip Yasopa, Nontiya Homkham, Pornthip Chompook This study was aimed to explore the association between potential factors including public health and social measures and the number of influenza patients in Thailand between 2014–2021. Secondary data from relevant agencies were collected. Generalized Estimating Equation (GEE) and regression coefficient (β) were performed at a significance level of 0.05. We found factors associated with number of influenza patients during the time prior to COVID-19 pandemic were monthly income per household (Adjusted β = -0.02; 95% CI: -0.03, -0.01), population density (Adjusted β = 1.00; 95% CI: 0.82, 1.18), rainy season (Adjusted β = 137.15; 95% CI: 86.17, 188.13) and winter time (Adjusted β = 56.46; 95% CI: 3.21, 109.71). During the time of COVID-19 pandemic, population density (Adjusted β = 0.20; 95% CI: 0.15, 0.26), rainy season (Adjusted β = -164.23; 95% CI: -229.93, -98.52), winter time (Adjusted β = 61.06; 95% CI: 0.71, 121.41), public health control measures (prohibition of entering to into an area with high number of COVID-19 infections (Adjusted β = -169.34; 95% CI: -233.52, -105.16), and restriction of travelling also reduced the number of influenza patients (Adjusted β = -66.88; 95% CI: -125.15, -8.62) were associated with number of influenza patients. This study commends strategies in monitoring influenza patients to focus on the areas with low income, high population density, and in specific seasons. Public health and social measures which can be implemented are prohibition of entering to risk-areas (lock down), and restriction of travelling across provinces which their effectiveness in reducing influenza infections.
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6
Evaluation of SARS-CoV-2 interferon gamma release assay in BNT162b2 vaccinated healthcare workers
Angélica Ramos, Sandra Martins, Ana Sofia Marinho, Pedro Norton, Maria João Cardoso, João Tiago Guimarães
PLoS One Infectious Diseases, 11.05.2024
Tilføjet 11.05.2024
by Angélica Ramos, Sandra Martins, Ana Sofia Marinho, Pedro Norton, Maria João Cardoso, João Tiago Guimarães To predict protective immunity to SARS-CoV-2, cellular immunity seems to be more sensitive than humoral immunity. Through an Interferon-Gamma (IFN-γ) Release Assay (IGRA), we show that, despite a marked decrease in total antibodies, 94.3% of 123 healthcare workers have a positive cellular response 6 months after inoculation with the 2nd dose of BNT162b2 vaccine. Despite the qualitative relationship found, we did not observe a quantitative correlation between IFN-γ and IgG levels against SARS-CoV-2. Using stimulated whole blood from a subset of participants, we confirmed the specific T-cell response to SARS-CoV-2 by dosing elevated levels of the IL-6, IL-10 and TNF-α. Through a 20-month follow-up, we found that none of the infected participants had severe COVID-19 and that the first positive cases were only 12 months after the 2nd dose inoculation. Future studies are needed to understand if IGRA-SARS-CoV-2 can be a powerful diagnostic tool to predict future COVID-19 severe disease, guiding vaccination policies.
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7
Open-source data pipeline for street-view images: A case study on community mobility during COVID-19 pandemic
Matthew Martell, Nick Terry, Ribhu Sengupta, Chris Salazar, Nicole A. Errett, Scott B. Miles, Joseph Wartman, Youngjun Choe
PLoS One Infectious Diseases, 11.05.2024
Tilføjet 11.05.2024
by Matthew Martell, Nick Terry, Ribhu Sengupta, Chris Salazar, Nicole A. Errett, Scott B. Miles, Joseph Wartman, Youngjun Choe Street View Images (SVI) are a common source of valuable data for researchers. Researchers have used SVI data for estimating pedestrian volumes, demographic surveillance, and to better understand built and natural environments in cityscapes. However, the most common source of publicly available SVI data is Google Street View. Google Street View images are collected infrequently, making temporal analysis challenging, especially in low population density areas. Our main contribution is the development of an open-source data pipeline for processing 360-degree video recorded from a car-mounted camera. The video data is used to generate SVIs, which then can be used as an input for longitudinal analysis. We demonstrate the use of the pipeline by collecting an SVI dataset over a 38-month longitudinal survey of Seattle, WA, USA during the COVID-19 pandemic. The output of our pipeline is validated through statistical analyses of pedestrian traffic in the images. We confirm known results in the literature and provide new insights into outdoor pedestrian traffic patterns. This study demonstrates the feasibility and value of collecting and using SVI for research purposes beyond what is possible with currently available SVI data. Our methods and dataset represent a first of its kind longitudinal collection and application of SVI data for research purposes. Limitations and future improvements to the data pipeline and case study are also discussed.
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8
SARS-CoV-2 clade dynamics and their associations with hospitalisations during the first two years of the COVID-19 pandemic
Taavi Päll, Aare Abroi, Radko Avi, Heiki Niglas, Arina Shablinskaja, Merit Pauskar, Ene-Ly Jõgeda, Hiie Soeorg, Eveli Kallas, Andrio Lahesaare, Kai Truusalu, Dagmar Hoidmets, Olga Sadikova, Kaspar Ratnik, Hanna Sepp, Liidia Dotsenko, Jevgenia Epštein, Heleene Suija, Katrin Kaarna, Steven Smit, Lili Milani, Mait Metspalu, Ott Eric Oopkaup, Ivar Koppel, Erik Jaaniso, Ivan Kuzmin, Heleri Inno, Uku Raudvere, Mari-Anne Härma, Paul Naaber, Tuuli Reisberg, Hedi Peterson, Ulvi Gerst Talas, Irja Lutsar, Kristi Huik
PLoS One Infectious Diseases, 11.05.2024
Tilføjet 11.05.2024
by Taavi Päll, Aare Abroi, Radko Avi, Heiki Niglas, Arina Shablinskaja, Merit Pauskar, Ene-Ly Jõgeda, Hiie Soeorg, Eveli Kallas, Andrio Lahesaare, Kai Truusalu, Dagmar Hoidmets, Olga Sadikova, Kaspar Ratnik, Hanna Sepp, Liidia Dotsenko, Jevgenia Epštein, Heleene Suija, Katrin Kaarna, Steven Smit, Lili Milani, Mait Metspalu, Ott Eric Oopkaup, Ivar Koppel, Erik Jaaniso, Ivan Kuzmin, Heleri Inno, Uku Raudvere, Mari-Anne Härma, Paul Naaber, Tuuli Reisberg, Hedi Peterson, Ulvi Gerst Talas, Irja Lutsar, Kristi Huik Background The COVID-19 pandemic was characterised by rapid waves of disease, carried by the emergence of new and more infectious SARS-CoV-2 virus variants. How the pandemic unfolded in various locations during its first two years has yet to be sufficiently covered. To this end, here we are looking at the circulating SARS-CoV-2 variants, their diversity, and hospitalisation rates in Estonia in the period from March 2000 to March 2022. Methods We sequenced a total of 27,550 SARS-CoV-2 samples in Estonia between March 2020 and March 2022. High-quality sequences were genotyped and assigned to Nextstrain clades and Pango lineages. We used regression analysis to determine the dynamics of lineage diversity and the probability of clade-specific hospitalisation stratified by age and sex. Results We successfully sequenced a total of 25,375 SARS-CoV-2 genomes (or 92%), identifying 19 Nextstrain clades and 199 Pango lineages. In 2020 the most prevalent clades were 20B and 20A. The various subsequent waves of infection were driven by 20I (Alpha), 21J (Delta) and Omicron clades 21K and 21L. Lineage diversity via the Shannon index was at its highest during the Delta wave. About 3% of sequenced SARS-CoV-2 samples came from hospitalised individuals. Hospitalisation increased markedly with age in the over-forties, and was negligible in the under-forties. Vaccination decreased the odds of hospitalisation in over-forties. The effect of vaccination on hospitalisation rates was strongly dependent upon age but was clade-independent. People who were infected with Omicron clades had a lower hospitalisation likelihood in age groups of forty and over than was the case with pre-Omicron clades regardless of vaccination status. Conclusions COVID-19 disease waves in Estonia were driven by the Alpha, Delta, and Omicron clades. Omicron clades were associated with a substantially lower hospitalisation probability than pre-Omicron clades. The protective effect of vaccination in reducing hospitalisation likelihood was independent of the involved clade.
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9
Mode of delivery and birth outcomes before and during COVID-19 –A population-based study in Ontario, Canada
Teresa To, Jingqin Zhu, Emilie Terebessy, Cornelia M. Borkhoff, Andrea S. Gershon, Tetyana Kendzerska, Smita S. Pakhale, Nicholas T. Vozoris, Kimball Zhang, Christopher Licskai
PLoS One Infectious Diseases, 11.05.2024
Tilføjet 11.05.2024
by Teresa To, Jingqin Zhu, Emilie Terebessy, Cornelia M. Borkhoff, Andrea S. Gershon, Tetyana Kendzerska, Smita S. Pakhale, Nicholas T. Vozoris, Kimball Zhang, Christopher Licskai There is lack of clarity on whether pregnancies during COVID-19 resulted in poorer mode of delivery and birth outcomes in Ontario, Canada. We aimed to compare mode of delivery (C-section), birth (low birthweight, preterm birth, NICU admission), and health services use (HSU, hospitalizations, ED visits, physician visits) outcomes in pregnant Ontario women before and during COVID-19 (pandemic periods). We further stratified for pre-existing chronic diseases (asthma, eczema, allergic rhinitis, diabetes, hypertension). Deliveries before (Jun 2018–Feb 2020) and during (Jul 2020–Mar 2022) pandemic were from health administrative data. We used multivariable logistic regression analyses to estimate adjusted odds ratios (aOR) of delivery and birth outcomes, and negative binomial regression for adjusted rate ratios (aRR) of HSU. We compared outcomes between pre-pandemic and pandemic periods. Possible interactions between study periods and covariates were also examined. 323,359 deliveries were included (50% during pandemic). One in 5 (18.3%) women who delivered during the pandemic had not received any COVID-19 vaccine, while one in 20 women (5.2%) lab-tested positive for COVID-19. The odds of C-section delivery during the pandemic was 9% higher (aOR = 1.09, 95% CI: 1.08–1.11) than pre-pandemic. The odds of preterm birth and NICU admission were 15% (aOR = 0.85, 95% CI: 0.82–0.87) and 10% lower (aOR = 0.90, 95% CI: 0.88–0.92), respectively, during COVID-19. There was a 17% reduction in ED visits but a 16% increase in physician visits during the pandemic (aRR = 0.83, 95% CI: 0.81–0.84 and aRR = 1.16, 95% CI: 1.16–1.17, respectively). These aORs and aRRs were significantly higher in women with pre-existing chronic conditions. During the pandemic, healthcare utilization, especially ED visits (aRR = 0.83), in pregnant women was lower compared to before. Ensuring ongoing prenatal care during the pandemic may reduce risks of adverse mode of delivery and the need for acute care during pregnancy.
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10
COVID-19 Vaccination Linked With Lower Risk of Cardiac Problems
Journal of the American Medical Association, 10.05.2024
Tilføjet 10.05.2024
People who received a SARS-CoV-2 vaccination had a lower risk of heart failure and blood clots in their veins and arteries after COVID-19 infection than those who had not been vaccinated, a recent study involving more than 20 million participants in Estonia, Spain, and the UK found.
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11
Trials Will Evaluate Treatments for Long COVID Nervous System Problems
Journal of the American Medical Association, 10.05.2024
Tilføjet 10.05.2024
For some individuals, post–COVID-19 condition, or long COVID, can result in symptoms of autonomic nervous system dysfunction, such as a heart palpitations and lightheadedness that occur when standing up, and fatigue. Together, these symptoms are known as postural orthostatic tachycardia syndrome (POTS).
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12
Consortium Authors and Nonauthor Collaborators Added
Journal of the American Medical Association, 10.05.2024
Tilføjet 10.05.2024
The Original Investigation titled “Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection,” published in the June 13, 2023, issue of JAMA, has been corrected to include additional consortium authors and nonauthor collaborator names in a supplement.
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13
Correction: mHealth intervention to improve quality of life in patients with chronic diseases during the COVID-19 crisis in Paraguay: A study protocol for a randomized controlled trial
The PLOS One Staff
PLoS One Infectious Diseases, 10.05.2024
Tilføjet 10.05.2024
14
FURIN, IFNL4, and TLR2 gene polymorphisms in relation to COVID-19 severity: a case–control study in Egyptian patients
Infection, 10.05.2024
Tilføjet 10.05.2024
Abstract Background and Aim A wide range of clinical manifestations and outcomes, including liver injury, have been reported in COVID-19 patients. We investigated the association of three substantial gene polymorphisms (FURIN, IFNL4, and TLR2) with COVID-19 disease susceptibility and severity to help predict prognosis. Methods 150 adult COVID-19-assured cases were categorized as follows: 78 patients with a non-severe presentation, 39 patients with severe disease, and 33 critically ill patients. In addition, 74 healthy controls were included. Clinical and laboratory evaluations were carried out, including complete and differential blood counts, D-dimer, lactate dehydrogenase (LDH), C-reactive protein (CRP), procalcitonin, ferritin, interleukin-6 (Il-6), and liver and kidney functions. FURIN (rs6226), IFNL4 (rs12979860), and TLR2 (rs3804099) genotyping allelic discrimination assays were conducted using real-time PCR. Results The FURIN, IFNL4, and TLR2 genotypes and their alleles differed significantly between COVID-19 patients and controls, as well as between patients with severe or critical illness and those with a non-severe presentation. According to a multivariable regression analysis, FURIN (C/T + T/T) and TLR2 (T/C + C/C) mutants were associated with COVID-19 susceptibility, with odds ratios of 3.293 and 2.839, respectively. FURIN C/C and IFNL4 T/T mutants were significantly linked to severe and critical illnesses. Multivariate regression analysis showed that FURIN (G/C + C/C) genotypes and IFNL4 T/T homozygosity were independent risk factors associated with increased mortality. Conclusion FURIN, IFNL4, and TLR2 gene variants are associated with the risk of COVID-19 occurrence as well as increased severity and poor outcomes in Egyptian patients.
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15
Long-term symptoms after SARS-CoV-2 infection in a cohort of people living with HIV
Infection, 10.05.2024
Tilføjet 10.05.2024
Abstract Background Our Hospital in Northern Italy assists 3817 people living with HIV (PLWH) and has faced the impact of COVID-19. Little is known about the impact of HIV infection on the risk of post-COVID-19 conditions (PCCs) onset. We aim to assess the incidence of PCC in PLWH and the factors associated with its occurrence. Methods We performed a retrospective, observational study including all PLWH > 18 years registered in the Brescia Health Protection Agency database, assessing SARS-CoV-2 burden, vaccination status, socio-demographic, and viro-immunological parameters from February 2020 until May 2022. Persistence of self-reported symptoms (clustered into gastrointestinal, respiratory, osteo-muscular, and neuro-behavioral symptoms) was evaluated after 3 months by a telephone-administered questionnaire. We estimated the associations between all variables and outcomes through univariate and multivariable logistic models. Results In the study period, 653 PLWH were diagnosed with SARS-CoV-2 infection (17.1%). We observed 19 (2.9%) reinfections, 71 (10.9%) hospitalizations, and 3 (0.5%) deaths. We interviewed 510/653 PLWH (78%), and 178 (PCCs prevalence 34.9%; CI 95% 30.7–39.2) reported persistent symptoms. Asthenia/fatigue was the most reported symptom (60/178), followed by muscular pain (54/178). In the multivariate regression model, there was a lower risk of PCCs in males respect to females (adjusted OR = 0.64; CI 95% 0.99–3.66), while hospitalization during acute infection was associated with an increased the risk of PCCs (adjusted OR = 1.9; CI 95% 0.99–3.66). Notably, no viro-immunological variable modified the PCCs risk onset. Conclusions Our study highlights a substantial prevalence of PCCs among PLWH, three months post-SARS-CoV-2 infection, independent of viro-immunological features or vaccination status.
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16
Comparison of post-COVID-19 symptoms in patients infected with the SARS-CoV-2 variants delta and omicron—results of the Cross-Sectoral Platform of the German National Pandemic Cohort Network (NAPKON-SUEP)
Infection, 10.05.2024
Tilføjet 10.05.2024
Abstract Purpose The influence of new SARS-CoV-2 variants on the post-COVID-19 condition (PCC) remains unanswered. Therefore, we examined the prevalence and predictors of PCC-related symptoms in patients infected with the SARS-CoV-2 variants delta or omicron. Methods We compared prevalences and risk factors of acute and PCC-related symptoms three months after primary infection (3MFU) between delta- and omicron-infected patients from the Cross-Sectoral Platform of the German National Pandemic Cohort Network. Health-related quality of life (HrQoL) was determined by the EQ-5D-5L index score and trend groups were calculated to describe changes of HrQoL between different time points. Results We considered 758 patients for our analysis (delta: n = 341; omicron: n = 417). Compared with omicron patients, delta patients had a similar prevalence of PCC at the 3MFU (p = 0.354), whereby fatigue occurred most frequently (n = 256, 34%). HrQoL was comparable between the groups with the lowest EQ-5D-5L index score (0.75, 95% CI 0.73–0.78) at disease onset. While most patients (69%, n = 348) never showed a declined HrQoL, it deteriorated substantially in 37 patients (7%) from the acute phase to the 3MFU of which 27 were infected with omicron. Conclusion With quality-controlled data from a multicenter cohort, we showed that PCC is an equally common challenge for patients infected with the SARS-CoV-2 variants delta and omicron at least for the German population. Developing the EQ-5D-5L index score trend groups showed that over two thirds of patients did not experience any restrictions in their HrQoL due to or after the SARS-CoV-2 infection at the 3MFU. Clinical Trail registration The cohort is registered at ClinicalTrials.gov since February 24, 2021 (Identifier: NCT04768998).
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17
Understanding associations between the COVID-19 pandemic and menstrual hygiene management among adolescent girls in Ethiopia: findings from a mixed-methods longitudinal study
Murphy, M., Dutton, R., Gezahegne, K., Jones, N., Seager, J., Baird, S.
BMJ Open, 9.05.2024
Tilføjet 9.05.2024
ObjectiveTo understand the relationship between the COVID-19 pandemic and menstrual hygiene management (MHM) among adolescent girls in Ethiopia and to explore which girls were most affected by pandemic disruptions. DesignTwo rounds of data from surveys and interviews were collected with adolescent girls immediately prior to and during the COVID-19 pandemic. The primary analysis is cross-sectional, controlling for pre-COVID-19 covariates. SettingThe setting was three zones in two regions of Ethiopia: East Hararghe and East Shewa Zones in Oromia and South Gondar Zone in Amhara. Data were collected in December 2019–March 2020 and September 2020–February 2021. Participants742 adolescent girls, ages 11–25 years. Outcome measuresFour primary outcomes were explored (1) the number of challenges girls experienced; (2) adolescent-identified challenges managing menstrual hygiene; (3) adolescent-identified difficulties accessing MHM products and (4) adolescent-identified difficulties accessing soap or water. ResultsGirls who were more vulnerable to COVID-19 were more likely to have worse MHM outcomes. An SD increase in household vulnerability to COVID-19 was associated with an 8.7 percentage point increase in the likelihood that the respondent had difficulty getting MHM products (p
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18
Did COVID-19 ICU patient mortality risk increase as Colorado hospitals filled? A retrospective cohort study
Johnson, D. R., Ghosh, D., Wagner, B. D., Carlton, E. J.
BMJ Open, 9.05.2024
Tilføjet 9.05.2024
ObjectivesTo assess whether increasing levels of hospital stress—measured by intensive care unit (ICU) bed occupancy (primary), ventilators in use and emergency department (ED) overflow—were associated with decreasing COVID-19 ICU patient survival in Colorado ICUs during the pre-Delta, Delta and Omicron variant eras. DesignA retrospective cohort study using discrete-time survival models, fit with generalised estimating equations. Setting34 hospital systems in Colorado, USA, with the highest patient volume ICUs during the COVID-19 pandemic. Participants9196 non-paediatric SARS-CoV-2 patients in Colorado hospitals admitted once to an ICU between 1 August 2020 and 1 March 2022 and followed for 28 days. Outcome measuresDeath or discharge to hospice. ResultsFor Delta-era COVID-19 ICU patients in Colorado, the odds of death were estimated to be 26% greater for patients exposed every day of their ICU admission to a facility experiencing its all-era 75th percentile ICU fullness or above, versus patients exposed for none of their days (OR: 1.26; 95% CI: 1.04 to 1.54; p=0.0102), adjusting for age, sex, length of ICU stay, vaccination status and hospital quality rating. For both Delta-era and Omicron-era patients, we also detected significantly increased mortality hazard associated with high ventilator utilisation rates and (in a subset of facilities) states of ED overflow. For pre-Delta-era patients, we estimated relatively null or even protective effects for the same fullness exposures, something which provides a meaningful contrast to previous studies that found increased hazards but were limited to pre-Delta study windows. ConclusionsOverall, and especially during the Delta era (when most Colorado facilities were at their fullest), increasing exposure to a fuller hospital was associated with an increasing mortality hazard for COVID-19 ICU patients.
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19
Simple mathematical model for predicting COVID-19 outbreaks in Japan based on epidemic waves with a cyclical trend
BMC Infectious Diseases, 9.05.2024
Tilføjet 9.05.2024
Abstract Background Several models have been used to predict outbreaks during the COVID-19 pandemic, with limited success. We developed a simple mathematical model to accurately predict future epidemic waves. Methods We used data from the Ministry of Health, Labour and Welfare of Japan for newly confirmed COVID-19 cases. COVID-19 case data were summarized as weekly data, and epidemic waves were visualized and identified. The periodicity of COVID-19 in each prefecture of Japan was confirmed using time-series analysis and the autocorrelation coefficient, which was used to investigate the longer-term pattern of COVID-19 cases. Outcomes using the autocorrelation coefficient were visualized via a correlogram to capture the periodicity of the data. An algorithm for a simple prediction model of the seventh COVID-19 wave in Japan comprised three steps. Step 1: machine learning techniques were used to depict the regression lines for each epidemic wave, denoting the “rising trend line”; Step 2: an exponential function with good fit was identified from data of rising straight lines up to the sixth wave, and the timing of the rise of the seventh wave and speed of its spread were calculated; Step 3: a logistic function was created using the values calculated in Step 2 as coefficients to predict the seventh wave. The accuracy of the model in predicting the seventh wave was confirmed using data up to the sixth wave. Results Up to March 31, 2023, the correlation coefficient value was approximately 0.5, indicating significant periodicity. The spread of COVID-19 in Japan was repeated in a cycle of approximately 140 days. Although there was a slight lag in the starting and peak times in our predicted seventh wave compared with the actual epidemic, our developed prediction model had a fairly high degree of accuracy. Conclusion Our newly developed prediction model based on the rising trend line could predict COVID-19 outbreaks up to a few months in advance with high accuracy. The findings of the present study warrant further investigation regarding application to emerging infectious diseases other than COVID-19 in which the epidemic wave has high periodicity.
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20
Humoral responses to multiple SARS-CoV-2 variants after two doses of vaccine in kidney transplant patients
Pin-Xian DuShen-Shin ChangTzong-Shiann HoHsi-Chang ShihPei-Shan TsaiGuan-Da Syua Department of Biotechnology and Bioindustry Sciences, National Cheng Kung University, Tainan, Taiwanb Division of Transplantation, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwanc Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan, Taiwand Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwane Department of Pediatrics, Tainan Hospital, Ministry of Health and Welfare, Yunlin, Taiwanf Department of Pediatrics, National Cheng Kung University Hospital Dou-Liou Branch, College of Medicine, National Cheng Kung University, Yunlin, Taiwang Department of Pharmacology and Molecular Sciences, JohnsHopkins University School of Medicine, Baltimore, USAh International Center for Wound Repair and Regeneration, National Cheng Kung University, Tainan, Taiwani Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
Virulence, 9.05.2024
Tilføjet 9.05.2024
21
COVID-19 Incidence, Risk Factors, Impact, and Related Stigma among a Cohort of Persons with HIV in Washington, DC
Barth, Shannon K.; Monroe, Anne K.; Houston, Patricia; Benator, Debra; Horberg, Michael; Castel, Amanda D.; On behalf of the DC Cohort Executive Committee
Journal of Acquired Immune Deficiency Syndromes, 9.05.2024
Tilføjet 9.05.2024
Background: Studies on the incidence of COVID-19 among persons with HIV (PWH) present varied results. Few studies have investigated the impact of COVID-19 infection on health and socioeconomic factors or COVID-19 stigma. We sought to measure the incidence and severity of COVID-19 infection among a cohort of PWH, characterize associated risk factors and impact, and document perceptions of COVID-19-related stigma. Methods: Data for this cross-sectional study come from the COVID-19 survey of participants in the DC Cohort longitudinal study from October 30, 2020 through December 31, 2022. Survey results were linked to electronic health records, including HIV labs and COVID test results. We conducted analyses comparing demographic, socioeconomic, HIV measures, and stigma among those with and without self-reported COVID-19. Results: Out of 1,972 survey respondents, 17% self-reported COVID-19 infection, with greatest incidence in the Omicron wave of the pandemic. We found statistically significant differences by age, employment status, essential worker status, education, and household income. Longer duration of HIV diagnosis was associated with greater incidence of COVID-19. PWH who were overweight or obese had greater incidence of COVID-19 compared to those who were not. Over 40% of PWH with COVID-19 reported experiencing at least one form of COVID-19-related stigma. Conclusion: We observed a high incidence of COVID-19 infection among PWH in DC. Further, a substantial proportion of PWH with COVID-19 reported experiencing COVID-19 related stigma. These findings add to the existing literature on COVID-19 co-infection among PWH and highlight the need for awareness and support for those experiencing COVID-19 stigma. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
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22
Study protocol for assessment of the efficacy of calcium dobesilate versus placebo on SARS-CoV-2 viral load in outpatients with COVID-19 (CADOVID study): a randomised, placebo-controlled, double-blind, monocentric phase II trial
Salamun, J., Da Silva, T., Ustero, P., Gosmain, Y., Guessous, I., Calmy, A., Spechbach, H.
BMJ Open, 8.05.2024
Tilføjet 8.05.2024
IntroductionSARS-CoV-2 mainly infects respiratory endothelial cells, which is facilitated through its spike protein binding to heparan sulphate. Calcium dobesilate (CaD) is a well-established, widely available vasoactive and angioprotective drug interacting with heparan sulphate, with the potential to interfere with the uptake of SARS-CoV-2 by epithelial cells. The CADOVID trial aims to evaluate the efficacy and safety of CaD in reducing the SARS-CoV-2 viral load in non-hospitalised adult patients diagnosed with COVID-19, confirmed by a positive SARS-CoV-2 PCR, including its efficacy to reduce the impact of persistent COVID-19 symptoms. Methods and analysisThis is a randomised, placebo-controlled, double-blind, monocentric phase II trial. Enrolment began in July 2022. A total of 74 adult patients will be randomly allocated to the CaD arm or the placebo group with a 1:1 ratio, respectively. Participants in the intervention arm will receive two capsules of CaD 500 mg two times per day and the placebo arm will receive two matching capsules of mannitol 312.5 mg two times per day, with a treatment period of 7 days for both arms, followed by a 77-day observational period without treatment administration. Participants will be asked to complete secured online questionnaires using their personal smartphone or other electronic device. These include a COVID-19 questionnaire (assessing symptoms, temperature measurement, reporting of concomitant medication and adverse events), a COVID-19 persistent symptoms’ questionnaire and the Short Form 12-Item (SF-12) survey. SARS-CoV-2 PCR testing will be performed on nasopharyngeal swabs collected on days 1, 4, 8 and 21. The primary endpoint is the reduction from baseline of SARS-CoV-2 viral load determined by RT-PCR at day 4. Ethics and disseminationThis trial has received approval by the Geneva Regional Research Ethics Committee (2022-00613) and Swissmedic (701339). Dissemination of results will be through presentations at scientific conferences and publication in scientific journals. Trial registration number NCT05305508; Clinicaltrials.gov; Swiss National Clinical Portal Registry (SNCTP 000004938).
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23
Impact of interventions to reduce nosocomial transmission of SARS-CoV-2 in English NHS Trusts: a computational modelling study
BMC Infectious Diseases, 8.05.2024
Tilføjet 8.05.2024
Abstract Background Prior to September 2021, 55,000–90,000 hospital inpatients in England were identified as having a potentially nosocomial SARS-CoV-2 infection. This includes cases that were likely missed due to pauci- or asymptomatic infection. Further, high numbers of healthcare workers (HCWs) are thought to have been infected, and there is evidence that some of these cases may also have been nosocomially linked, with both HCW to HCW and patient to HCW transmission being reported. From the start of the SARS-CoV-2 pandemic interventions in hospitals such as testing patients on admission and universal mask wearing were introduced to stop spread within and between patient and HCW populations, the effectiveness of which are largely unknown. Materials/methods Using an individual-based model of within-hospital transmission, we estimated the contribution of individual interventions (together and in combination) to the effectiveness of the overall package of interventions implemented in English hospitals during the COVID-19 pandemic. A panel of experts in infection prevention and control informed intervention choice and helped ensure the model reflected implementation in practice. Model parameters and associated uncertainty were derived using national and local data, literature review and formal elicitation of expert opinion. We simulated scenarios to explore how many nosocomial infections might have been seen in patients and HCWs if interventions had not been implemented. We simulated the time period from March-2020 to July-2022 encompassing different strains and multiple doses of vaccination. Results Modelling results suggest that in a scenario without inpatient testing, infection prevention and control measures, and reductions in occupancy and visitors, the number of patients developing a nosocomial SARS-CoV-2 infection could have been twice as high over the course of the pandemic, and over 600,000 HCWs could have been infected in the first wave alone. Isolation of symptomatic HCWs and universal masking by HCWs were the most effective interventions for preventing infections in both patient and HCW populations. Model findings suggest that collectively the interventions introduced over the SARS-CoV-2 pandemic in England averted 400,000 (240,000 – 500,000) infections in inpatients and 410,000 (370,000 – 450,000) HCW infections. Conclusions Interventions to reduce the spread of nosocomial infections have varying impact, but the package of interventions implemented in England significantly reduced nosocomial transmission to both patients and HCWs over the SARS-CoV-2 pandemic.
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24
Direct impact of COVID-19 vaccination in Chile: averted cases, hospitalizations, ICU admissions, and deaths
BMC Infectious Diseases, 8.05.2024
Tilføjet 8.05.2024
Abstract Background Chile rapidly implemented an extensive COVID-19 vaccination campaign, deploying a diversity of vaccines with a strategy that prioritized the elderly and individuals with comorbidities. This study aims to assess the direct impact of vaccination on the number of COVID-19 related cases, hospital admissions, ICU admissions and deaths averted during the first year and a half of the campaign. Methods Via Chile’s transparency law, we obtained access to weekly event counts categorized by vaccination status and age. Integrating this data with publicly available census and vaccination coverage information, we conducted a comparative analysis of weekly incidence rates between vaccinated and unvaccinated groups from December 20, 2020 to July 2, 2022 to estimate the direct impact of vaccination in terms of the number of cases, hospitalizations, ICU admissions and deaths averted, using an approach that avoids the need to explicitly specify the effectiveness of each vaccine deployed. Results We estimated that, from December 20, 2020 to July 2, 2022 the vaccination campaign directly prevented 1,030,648 (95% Confidence Interval: 1,016,975-1,044,321) cases, 268,784 (95% CI: 264,524-273,045) hospitalizations, 85,830 (95% CI: 83,466-88,194) ICU admissions and 75,968 (95% CI: 73,909-78,028) deaths related to COVID-19 among individuals aged 16 years and older. This corresponds to a reduction of 26% of cases, 66% of hospital admissions, 70% of ICU admissions and 67% of deaths compared to a scenario without vaccination. Individuals 55 years old or older represented 67% of hospitalizations, 73% of ICU admissions and 89% of deaths related to COVID-19 prevented. Conclusions This study highlights the role of Chile\'s vaccination campaign in reducing COVID-19 disease burden, with the most substantial reductions observed in severe outcomes.
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25
New framework to assess tracing and testing based on South Korea’s response to COVID-19
BMC Infectious Diseases, 8.05.2024
Tilføjet 8.05.2024
Abstract South Korea’s remarkable success in controlling the spread of COVID-19 during the pre-Omicron period was based on extensive contact tracing and large-scale testing. Here we suggest a general criterion for tracing and testing based on South Korea’s experience, and propose a new framework to assess tracing and testing. We reviewed papers on South Korea’s response to COVID-19 to capture its concept of tracing and testing. South Korea expanded its testing capabilities to enable group tracing combined with preemptive testing, and to conduct open testing. According to our proposed model, COVID-19 cases are classified into 4 types: confirmed in quarantine, source known, source unknown, and unidentified. The proportion of the first two case types among confirmed cases is defined as “traced proportion”, and used as the indicator of tracing and testing effectiveness. In conclusion, South Korea successfully suppressed COVID-19 transmission by maintaining a high traced proportion (> 60%) using group tracing in conjunction with preemptive testing as a complementary strategy to traditional contact tracing.
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26
An updated framework for SARS-CoV-2 variants reflects the unpredictability of viral evolution
Lorenzo Subissi, James Richard Otieno, Nathalie Worp, Homa Attar Cohen, Bas B. Oude Munnink, Laith J. Abu-Raddad, Erik Alm, Amal Barakat, Wendy S. Barclay, Jinal N. Bhiman, Leon Caly, Meera Chand, Mark Chen, Ann Cullinane, Tulio de Oliveira, Christian Drosten, Julian Druce, Paul Effler, Ihab El Masry, Adama Faye, Elodie Ghedin, Rebecca Grant, Bart L. Haagmans, Christian Happi, Belinda L. Herring, Emma B. Hodcroft, Juniorcaius Ikejezie, Victoria Katawera, Zyleen Alnashir Kassamali, Yee-Sin Leo, Gabriel M. Leung, Rebecca J. Kondor, Marco Marklewitz, Jairo Mendez-Rico, Nada M. Melhem, Vincent Munster, Karen Nahapetyan, Dhamari Naindoo, Djin-Ye Oh, Thomas P. Peacock, Malik Peiris, Zhibin Peng, Leo L. M. Poon, Andrew Rambaut, Senjuti Saha, Yinzhong Shen, Marilda M. Siqueira, Erik Volz, Sofonias K. Tessema, Volker Thiel, Henda Triki, Sylvie van der Werf, Karin von Eije, Jane Cunningham, Marion P. G. Koopmans, Anne von Gottberg, Anurag Agrawal, Maria D. Van Kerkhove
Nature, 8.05.2024
Tilføjet 8.05.2024
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FASTMAP—a flexible and scalable immunopeptidomics pipeline for HLA- and antigen-specific T-cell epitope mapping based on artificial antigen-presenting cells
Luisa Weisbrod, Luigi Capriotti, Marco Hofmann, Valerie Spieler, Herbert Dersch, Bernd Voedisch, Peter Schmidt, Susanne Knake
Frontiers in Immunology, 8.05.2024
Tilføjet 8.05.2024
The study of peptide repertoires presented by major histocompatibility complex (MHC) molecules and the identification of potential T-cell epitopes contribute to a multitude of immunopeptidome-based treatment approaches. Epitope mapping is essential for the development of promising epitope-based approaches in vaccination as well as for innovative therapeutics for autoimmune diseases, infectious diseases, and cancer. It also plays a critical role in the immunogenicity assessment of protein therapeutics with regard to safety and efficacy concerns. The main challenge emerges from the highly polymorphic nature of the human leukocyte antigen (HLA) molecules leading to the requirement of a peptide mapping strategy for a single HLA allele. As many autoimmune diseases are linked to at least one specific antigen, we established FASTMAP, an innovative strategy to transiently co-transfect a single HLA allele combined with a disease-specific antigen into a human cell line. This approach allows the specific identification of HLA-bound peptides using liquid chromatography–tandem mass spectrometry (LC-MS/MS). Using FASTMAP, we found a comparable spectrum of endogenous peptides presented by the most frequently expressed HLA alleles in the world’s population compared to what has been described in literature. To ensure a reliable peptide mapping workflow, we combined the HLA alleles with well-known human model antigens like coagulation factor VIII, acetylcholine receptor subunit alpha, protein structures of the SARS-CoV-2 virus, and myelin basic protein. Using these model antigens, we have been able to identify a broad range of peptides that are in line with already published and in silico predicted T-cell epitopes of the specific HLA/model antigen combination. The transient co-expression of a single affinity-tagged MHC molecule combined with a disease-specific antigen in a human cell line in our FASTMAP pipeline provides the opportunity to identify potential T-cell epitopes/endogenously processed MHC-bound peptides in a very cost-effective, fast, and customizable system with high-throughput potential.
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28
FURIN, IFNL4, and TLR2 gene polymorphisms in relation to COVID-19 severity: a case–control study in Egyptian patients
Infection, 8.05.2024
Tilføjet 8.05.2024
Abstract Background and Aim A wide range of clinical manifestations and outcomes, including liver injury, have been reported in COVID-19 patients. We investigated the association of three substantial gene polymorphisms (FURIN, IFNL4, and TLR2) with COVID-19 disease susceptibility and severity to help predict prognosis. Methods 150 adult COVID-19-assured cases were categorized as follows: 78 patients with a non-severe presentation, 39 patients with severe disease, and 33 critically ill patients. In addition, 74 healthy controls were included. Clinical and laboratory evaluations were carried out, including complete and differential blood counts, D-dimer, lactate dehydrogenase (LDH), C-reactive protein (CRP), procalcitonin, ferritin, interleukin-6 (Il-6), and liver and kidney functions. FURIN (rs6226), IFNL4 (rs12979860), and TLR2 (rs3804099) genotyping allelic discrimination assays were conducted using real-time PCR. Results The FURIN, IFNL4, and TLR2 genotypes and their alleles differed significantly between COVID-19 patients and controls, as well as between patients with severe or critical illness and those with a non-severe presentation. According to a multivariable regression analysis, FURIN (C/T + T/T) and TLR2 (T/C + C/C) mutants were associated with COVID-19 susceptibility, with odds ratios of 3.293 and 2.839, respectively. FURIN C/C and IFNL4 T/T mutants were significantly linked to severe and critical illnesses. Multivariate regression analysis showed that FURIN (G/C + C/C) genotypes and IFNL4 T/T homozygosity were independent risk factors associated with increased mortality. Conclusion FURIN, IFNL4, and TLR2 gene variants are associated with the risk of COVID-19 occurrence as well as increased severity and poor outcomes in Egyptian patients.
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29
Long-term symptoms after SARS-CoV-2 infection in a cohort of people living with HIV
Infection, 8.05.2024
Tilføjet 8.05.2024
Abstract Background Our Hospital in Northern Italy assists 3817 people living with HIV (PLWH) and has faced the impact of COVID-19. Little is known about the impact of HIV infection on the risk of post-COVID-19 conditions (PCCs) onset. We aim to assess the incidence of PCC in PLWH and the factors associated with its occurrence. Methods We performed a retrospective, observational study including all PLWH > 18 years registered in the Brescia Health Protection Agency database, assessing SARS-CoV-2 burden, vaccination status, socio-demographic, and viro-immunological parameters from February 2020 until May 2022. Persistence of self-reported symptoms (clustered into gastrointestinal, respiratory, osteo-muscular, and neuro-behavioral symptoms) was evaluated after 3 months by a telephone-administered questionnaire. We estimated the associations between all variables and outcomes through univariate and multivariable logistic models. Results In the study period, 653 PLWH were diagnosed with SARS-CoV-2 infection (17.1%). We observed 19 (2.9%) reinfections, 71 (10.9%) hospitalizations, and 3 (0.5%) deaths. We interviewed 510/653 PLWH (78%), and 178 (PCCs prevalence 34.9%; CI 95% 30.7–39.2) reported persistent symptoms. Asthenia/fatigue was the most reported symptom (60/178), followed by muscular pain (54/178). In the multivariate regression model, there was a lower risk of PCCs in males respect to females (adjusted OR = 0.64; CI 95% 0.99–3.66), while hospitalization during acute infection was associated with an increased the risk of PCCs (adjusted OR = 1.9; CI 95% 0.99–3.66). Notably, no viro-immunological variable modified the PCCs risk onset. Conclusions Our study highlights a substantial prevalence of PCCs among PLWH, three months post-SARS-CoV-2 infection, independent of viro-immunological features or vaccination status.
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Comparison of post-COVID-19 symptoms in patients infected with the SARS-CoV-2 variants delta and omicron—results of the Cross-Sectoral Platform of the German National Pandemic Cohort Network (NAPKON-SUEP)
Infection, 8.05.2024
Tilføjet 8.05.2024
Abstract Purpose The influence of new SARS-CoV-2 variants on the post-COVID-19 condition (PCC) remains unanswered. Therefore, we examined the prevalence and predictors of PCC-related symptoms in patients infected with the SARS-CoV-2 variants delta or omicron. Methods We compared prevalences and risk factors of acute and PCC-related symptoms three months after primary infection (3MFU) between delta- and omicron-infected patients from the Cross-Sectoral Platform of the German National Pandemic Cohort Network. Health-related quality of life (HrQoL) was determined by the EQ-5D-5L index score and trend groups were calculated to describe changes of HrQoL between different time points. Results We considered 758 patients for our analysis (delta: n = 341; omicron: n = 417). Compared with omicron patients, delta patients had a similar prevalence of PCC at the 3MFU (p = 0.354), whereby fatigue occurred most frequently (n = 256, 34%). HrQoL was comparable between the groups with the lowest EQ-5D-5L index score (0.75, 95% CI 0.73–0.78) at disease onset. While most patients (69%, n = 348) never showed a declined HrQoL, it deteriorated substantially in 37 patients (7%) from the acute phase to the 3MFU of which 27 were infected with omicron. Conclusion With quality-controlled data from a multicenter cohort, we showed that PCC is an equally common challenge for patients infected with the SARS-CoV-2 variants delta and omicron at least for the German population. Developing the EQ-5D-5L index score trend groups showed that over two thirds of patients did not experience any restrictions in their HrQoL due to or after the SARS-CoV-2 infection at the 3MFU. Clinical Trail registration The cohort is registered at ClinicalTrials.gov since February 24, 2021 (Identifier: NCT04768998).
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[Articles] Effect of molnupiravir on SARS-CoV-2 evolution in immunocompromised patients: a retrospective observational study
Nicholas M Fountain-Jones, Robert Vanhaeften, Jan Williamson, Janelle Maskell, I-Ly J Chua, Michael Charleston, Louise Cooley
The Lancet Microbe, 8.05.2024
Tilføjet 8.05.2024
Molnupiravir treatment in immunocompromised patients led to the accumulation of a distinctive pattern of mutations beyond the recommended 5 days of treatment. Treated patients maintained persistent PCR positivity for the duration of monitoring, indicating clear potential for transmission and subsequent emergence of novel variants.
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[Articles] Viral clearance as a surrogate of clinical efficacy for COVID-19 therapies in outpatients: a systematic review and meta-analysis
Karen M Elias, Shanchita R Khan, Eva Stadler, Timothy E Schlub, Deborah Cromer, Mark N Polizzotto, Stephen J Kent, Tari Turner, Miles P Davenport, David S Khoury
The Lancet Microbe, 8.05.2024
Tilføjet 8.05.2024
Despite the aggregation of studies with differing designs, and evidence of risk of bias in some virological outcomes, this review provides evidence that treatment-induced acceleration of viral clearance within the first 5 days after treatment is a potential surrogate of clinical efficacy to prevent hospitalisation with COVID-19. This work supports the use of viral clearance as an early phase clinical trial endpoint of therapeutic efficacy.
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[Articles] Optimisation and evaluation of viral genomic sequencing of SARS-CoV-2 rapid diagnostic tests: a laboratory and cohort-based study
Jillian S Paull, Brittany A Petros, Taylor M Brock-Fisher, Samantha A Jalbert, Victoria M Selser, Katelyn S Messer, Sabrina T Dobbins, Katherine C DeRuff, Davy Deng, Michael Springer, Pardis C Sabeti
The Lancet Microbe, 8.05.2024
Tilføjet 8.05.2024
RDT-derived swabs are a reasonable alternative to PCR swabs for viral genomic surveillance and outbreak investigation. RDT-derived lateral flow strips yield accurate, but significantly fewer, viral reads than matched PCR swabs. Metagenomic sequencing of negative RDTs can identify viruses that might underlie patient symptoms.
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34
[Articles] Antimicrobial-resistant Neisseria gonorrhoeae in Europe in 2020 compared with in 2013 and 2018: a retrospective genomic surveillance study
Daniel Golparian, Michelle J Cole, Leonor Sánchez-Busó, Michaela Day, Susanne Jacobsson, Thinushaa Uthayakumaran, Raquel Abad, Beatrice Bercot, Dominique A Caugant, Dagmar Heuer, Klaus Jansen, Sonja Pleininger, Paola Stefanelli, David M Aanensen, Benjamin Bluemel, Magnus Unemo, Euro-GASP study group
The Lancet Microbe, 8.05.2024
Tilføjet 8.05.2024
Azithromycin-resistant clones, mainly with mtrD mosaic or semi-mosaic variants, appear to be stabilising at a relatively high level in the EEA. This mostly low-level azithromycin resistance might threaten the recommended ceftriaxone-azithromycin therapy, but the negligible ceftriaxone resistance is encouraging. The decreased genomic population diversity and increased clonality could be explained in part by the COVID-19 pandemic resulting in lower importation of novel strains into Europe.
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35
Ventilation: Why Infectious Diseases Specialists should care
Martin Martinot
Clinical Microbiology and Infection, 8.05.2024
Tilføjet 8.05.2024
Since the beginning of the 21st century, in addition to the classical seasonal epidemics (influenza and respiratory syncytial virus [RSV]), many new airborne viral pandemics have emerged, namely, Severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1) in 2003, H1N1 influenza in 2009, Middle East respiratory syndrome coronavirus in 2012 and more recently, SARS-CoV-2 in 2019, which is still on-going. The magnitude of the SARS-CoV-2 pandemic has underscored the inaccuracy and limitations of previous measures for infection prevention.
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36
Frontline health workers experiences of providing care for people living with non-communicable diseases during the COVID-19 pandemic in Ghana: a qualitative study
Baatiema, L., de-Graft Aikins, A., Koram, K. K., Kunfah, S. M. P., Allen, L. N., Abimbola, S., Kruk, M.
BMJ Open, 8.05.2024
Tilføjet 8.05.2024
BackgroundThe COVID-19 pandemic has significantly impacted frontline health workers. However, a neglected dimension of this discourse was the extent to which the pandemic impacted frontline healthcare workers providing non-communicable diseases (NCDs) care. This study aims to understand the experiences of healthcare workers with no prior exposure to pandemics who provided care to people living with NCDs (PLWNCDs). MethodsA qualitative study design was employed, using a face-to-face in-depth interviews. Interviews were conducted in primary healthcare facilities in three administrative regions of Ghana, representing the Northern, Southern and Middle Belts. Only frontline health workers with roles in providing care for PLWNCDs were included. Purposive snowballing and convenience sampling methods were employed to select frontline health workers. An open-ended interview guide was used to facilitate data collection, and thematic content analysis was used to analyse the data. ResultsA total of 47 frontline health workers were interviewed. Overall, these workers experienced diverse patient-driven and organisational challenges. Patient-level challenges included a decline in healthcare utilisation, non-adherence to treatment, a lack of continuity, fear and stigma. At the organisational levels, there was a lack of medical logistics, increased infection of workers and absenteeism, increased workload and burnout, limited motivational packages and inadequate guidelines and protocols. Workers coped and responded to the pandemic by postponing reviews and consultations, reducing inpatient and outpatient visits, changing their prescription practices, using teleconsultation and moving to long-shift systems. ConclusionThis study has brought to the fore the experiences that adversely affected frontline health workers and, in many ways, affected the care provided to PLWNCDs. Policymakers and health managers should take these experiences into account in plans to mitigate the impact of future pandemics.
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Diversity, equity and inclusion considerations in mental health apps for young people: protocol for a scoping review
Figueroa, C. A., Perez-Flores, N. J., Guan, K. W., Stiles-Shields, C.
BMJ Open, 8.05.2024
Tilføjet 8.05.2024
IntroductionAfter COVID-19, a global mental health crisis affects young people, with one in five youth experiencing mental health problems worldwide. Delivering mental health interventions via mobile devices is a promising strategy to address the treatment gap. Mental health apps are effective for adolescent and young adult samples, but face challenges such as low real-world reach and under-representation of minoritised youth. To increase digital health uptake, including among minoritised youth, there is a need for diversity, equity and inclusion (DEI) considerations in the development and evaluation of mental health apps. How well DEI is integrated into youth mental health apps has not been comprehensively assessed. This scoping review aims to examine to what extent DEI considerations are integrated into the design and evaluation of youth mental health apps and report on youth, caregiver and other stakeholder involvement. Methods and analysisWe will identify studies published in English from 2009 to 29 September 2023 on apps for mental health in youth. We will use PubMed, Global Health, APA PsycINFO, SCOPUS, CINAHL PLUS and the Cochrane Database and will report according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review Extension guidelines. Papers eligible for inclusion must be peer-reviewed publications in English involving smartphone applications used by adolescents or young adults aged 10–25, with a focus on depression, anxiety or suicidal ideation. Two independent reviewers will review and extract articles using a template developed by the authors. We will analyse the data using narrative synthesis and descriptive statistics. This study will identify gaps in the literature and provide a roadmap for equitable and inclusive mental health apps for youth. Ethics and disseminationEthics approval is not required. Findings will be disseminated through academic, industry, community networks and scientific publications.
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38
Predictors of somatic symptoms during the COVID-19 pandemic: a national longitudinal survey in Japan
Sugawara, N., Tabuchi, T., Tokumitsu, K., Yasui-Furukori, N.
BMJ Open, 8.05.2024
Tilføjet 8.05.2024
ObjectivesThe COVID-19 pandemic has highlighted the long-term consequences of SARS-CoV-2 infection, termed long COVID. However, in the absence of comparative groups, the differentiation of disease progression remains difficult, as COVID-19 symptoms become indistinguishable from symptoms originating from alternative etiologies. This study aimed to longitudinally investigate the association between COVID-19 exposure and the somatic symptoms in the Japanese general population. DesignThis was a longitudinal cohort study with 1-year follow-up. Setting and participantsLongitudinal data from 19 545 individuals who participated in the Japan Society and New Tobacco Internet Survey (JASTIS) 2022 and 2023 were included. In this study, we used data from the 2022 JASTIS as baseline data and the 2023 JASTIS as follow-up data. Based on questionnaire responses, respondents were classified into three categories of exposure to COVID-19. Outcome measuresThe somatic symptoms were assessed by the Somatic Symptom Scale-8 (SSS-8). Using generalised linear models adjusted for baseline covariates, we calculated the ORs of having very high somatic symptoms assessed by SSS-8, attributable to COVID-19 exposure (no COVID-19 cases as the reference group). ResultsFollow-up completers were divided into three groups according to COVID-19 exposure (no COVID-19, n=16 012; COVID-19 without O2 therapy, n=3201; COVID-19 with O2 therapy, n=332). After adjusting for all covariates, COVID-19 cases with O2 therapy had a significant positive association (OR 7.60, 95% CI 5.47 to 10.58) with a very high somatic symptoms burden while other COVID-19 exposure groups did not. Pre-existing physical and psychological conditions were also associated with increased risk of somatic symptoms. ConclusionThe findings of our study suggest that the severity of COVID-19 symptoms requiring O2 therapy in the acute phase led to high somatic symptoms. Pre-existing conditions were also associated with a subsequent risk of somatic symptoms.
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Where does physical activity fit into preschool postpandemic? A qualitative exploration with parents, teachers and administrators
Zulauf-McCurdy, C., Tessema, B., Tang, R., Almeida, S., Tandon, P. S.
BMJ Open, 8.05.2024
Tilføjet 8.05.2024
ObjectivesDuring the preschool years, children depend on adult caregivers to provide opportunities for physical activity (PA). Research has focused on measuring PA in preschool, as well as barriers and facilitators to children’s PA but caregiver perceptions remain largely unknown especially in light of the COVID-19 pandemic. This study aims to understand the value of PA in preschool following the pandemic from three types of adult caregivers, parents of a young child (n=7), preschool teachers (n=7) and preschool administrators (n=7). MethodsIn-depth qualitative interviews were conducted to explore the following research questions: (a) how do caregivers describe the importance of PA in preschool postpandemic? (b) how do caregivers support and prioritise PA in preschool postpandemic and what challenges do they face in doing so? and (c) how do caregivers interact with one another to promote PA? Qualitative answers were coded using a codebook developed to answer the research questions of interest. ResultsParents, teachers and administrators all described valuing PA for preschoolers, but each caregiver type described a different way of promoting it. All the caregivers listed barriers that inhibit their ability to prioritise and promote PA, some heightened postpandemic. Lastly, there were limited caregiver interactions when it came to promoting PA, with the burden largely falling on teachers. ConclusionOur findings indicate that one particularly important area for intervention is supporting parents, teachers and preschool administrators in creating a shared understanding of the importance of PA for young children and ways to collaborate to promote it.
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Cohort profile: EFTER-COVID - a Danish nationwide cohort for assessing the long-term health effects of the COVID-19 pandemic
Sorensen, A. I. V., Bager, P., Nielsen, N. M., Koch, A., Spiliopoulos, L., Hviid, A., Ethelberg, S.
BMJ Open, 7.05.2024
Tilføjet 7.05.2024
PurposeTo follow SARS-CoV-2-infected persons up to 18 months after a positive test in order to assess the burden and nature of post acute symptoms and health problems. ParticipantsPersons in Denmark above 15 years of age, who were tested positive for SARS-CoV-2 during 1 September 2020 to 21 February 2023 using a RT-PCR test. As a reference group, three test-negative individuals were selected for every two test-positive individuals by matching on test date. Findings to dateIn total, 2 427 913 invitations to baseline questionnaires have been sent out and 839 528 baseline questionnaires (34.5%) have been completed. Females, the age group 50–69 years, Danish-born and persons, who had received at least one SARS-CoV-2 vaccination booster dose were more likely to participate. Follow-up questionnaires were sent at 2, 4, 6, 9, 12 and 18 months after the test, with response rates at 42%–54%. Future plansNew participants have been recruited on a daily basis from 1 August 2021 to 23 March 2023. Data collection will continue until the last follow-up questionnaires (at 18 months after test) have been distributed in August 2024.
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The Effect of COVID-19 Vaccination on Outpatient Antibiotic Prescribing in Older Adults: A Self-Controlled Risk-Interval Study
Clinical Infectious Diseases, 6.05.2024
Tilføjet 6.05.2024
Abstract Background Coronavirus disease 2019 (COVID-19) vaccination has been associated with reduced outpatient antibiotic prescribing among older adults with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We assessed the impact of COVID-19 vaccination on outpatient antibiotic prescribing in the broader population of older adults, regardless of SARS-CoV-2 infection status.Methods We included adults aged ≥65 years who received their first, second, and/or third COVID-19 vaccine dose from December 2020 to December 2022. We used a self-controlled risk-interval design and included cases who received an antibiotic prescription 2–6 weeks before vaccination (pre-vaccination or control interval) or after vaccination (post-vaccination or risk interval). We used conditional logistic regression to estimate the odds of being prescribed (1) any antibiotic, (2) a typical “respiratory” infection antibiotic, or (3) a typical “urinary tract” infection antibiotic (negative control) in the post-vaccination interval versus the pre-vaccination interval. We accounted for temporal changes in antibiotic prescribing using background monthly antibiotic prescribing counts.Results 469 923 vaccine doses met inclusion criteria. The odds of receiving any antibiotic or a respiratory antibiotic prescription were lower in the post-vaccination versus pre-vaccination interval (aOR, .973; 95% CI, .968–.978; aOR, .961; 95% CI, .953–.968, respectively). There was no association between vaccination and urinary antibiotic prescriptions (aOR, .996; 95% CI, .987–1.006). Periods with high (>10%) versus low (
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A joint penalized spline smoothing model for the number of positive and negative COVID-19 tests
Dries De Witte, Ariel Alonso Abad, Thomas Neyens, Geert Verbeke, Geert Molenberghs
PLoS One Infectious Diseases, 6.05.2024
Tilføjet 6.05.2024
by Dries De Witte, Ariel Alonso Abad, Thomas Neyens, Geert Verbeke, Geert Molenberghs One of the key tools to understand and reduce the spread of the SARS-CoV-2 virus is testing. The total number of tests, the number of positive tests, the number of negative tests, and the positivity rate are interconnected indicators and vary with time. To better understand the relationship between these indicators, against the background of an evolving pandemic, the association between the number of positive tests and the number of negative tests is studied using a joint modeling approach. All countries in the European Union, Switzerland, the United Kingdom, and Norway are included in the analysis. We propose a joint penalized spline model in which the penalized spline is reparameterized as a linear mixed model. The model allows for flexible trajectories by smoothing the country-specific deviations from the overall penalized spline and accounts for heteroscedasticity by allowing the autocorrelation parameters and residual variances to vary among countries. The association between the number of positive tests and the number of negative tests is derived from the joint distribution for the random intercepts and slopes. The correlation between the random intercepts and the correlation between the random slopes were both positive. This suggests that, when countries increase their testing capacity, both the number of positive tests and negative tests will increase. A significant correlation was found between the random intercepts, but the correlation between the random slopes was not significant due to a wide credible interval.
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43
CT abnormalities 3 and 12 months after hospitalization for COVID-19 and association with disease severity: A prospective cohort study
Trond Mogens Aaløkken, Haseem Ashraf, Gunnar Einvik, Tøri Vigeland Lerum, Carin Meltzer, Jezabel Rivero Rodriguez, Ole Henning Skjønsberg, Knut Stavem
PLoS One Infectious Diseases, 6.05.2024
Tilføjet 6.05.2024
by Trond Mogens Aaløkken, Haseem Ashraf, Gunnar Einvik, Tøri Vigeland Lerum, Carin Meltzer, Jezabel Rivero Rodriguez, Ole Henning Skjønsberg, Knut Stavem Objectives To investigate changes in chest CT between 3 and 12 months and associations with disease severity in patients hospitalized for COVID-19 during the first wave in 2020. Materials and methods Longitudinal cohort study of patients hospitalized for COVID-19 in 2020. Chest CT was performed 3 and 12 months after admission. CT images were evaluated using a CT severity score (CSS) (0–12 scale) and recoded to an abbreviated version (0–3 scale). We analyzed determinants of the abbreviated CSS with multivariable mixed effects ordinal regression. Results 242 patients completed CT at 3 months, and 124 (mean age 62.3±13.3, 78 men) also at 12 months. Between 3 and 12 months (n = 124) CSS (0–12 scale) for ground-glass opacities (GGO) decreased from median 3 (25th–75th percentile: 0–12) at 3 months to 0.5 (0–12) at 12 months (p
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44
[Articles] Association of nirmatrelvir–ritonavir with post-acute sequelae and mortality in patients admitted to hospital with COVID-19: a retrospective cohort study
Huwen Wang, Yuchen Wei, Chi Tim Hung, Guozhang Lin, Xiaoting Jiang, Conglu Li, Katherine Min Jia, Carrie Ho Kwan Yam, Tsz Yu Chow, Janice Ying-en Ho, Yawen Wang, Shi Zhao, Zihao Guo, Kehang Li, Aimin Yang, Chris Ka Pun Mok, David S C Hui, Eng Kiong Yeoh, Ka Chun Chong
Lancet Infectious Diseases, 4.05.2024
Tilføjet 4.05.2024
This study showed extended benefits of nirmatrelvir–ritonavir for reducing the risk of post-acute inpatient death as well as cardiovascular and respiratory complications among patients admitted to hospital with COVID-19. Further research is essential to uncover the underlying mechanisms responsible for these observed negative associations and to devise effective strategies for preventing the onset of post-acute sequelae.
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45
Maternal distress during the COVID-19 outbreak: A socio-ecological perspective
Mor Keleynikov, Noga Cohen, Joy Benatov
PLoS One Infectious Diseases, 4.05.2024
Tilføjet 4.05.2024
by Mor Keleynikov, Noga Cohen, Joy Benatov Introduction Mothers faced an increased risk of adverse mental health outcomes during the COVID-19 pandemic compared to other populations. However, there is little data on the factors that placed mothers at increased risk of distress. Aims The present study explored a range of individual, familial, and environmental factors associated with psychological distress in mothers during the COVID-19 pandemic. Method This repeated cross-sectional study was composed of a convenience sample of mothers who completed an online survey that included a demographic questionnaire, an emotion regulation questionnaire, and the Depression, Anxiety, and Stress scale. The survey was administered during the second and third lockdowns in Israel in 2020–2021. Results The study included 575 mothers (M age = 39). The findings of a hierarchical regression indicated that individual-level factors, composed of age and emotion regulation tendencies predicted psychological distress. The family-level factors of household income and number of children in the family also predicted distress. In terms of environmental-level factors, COVID-19-related media consumption and school status (open or closed) were also significant predictors of psychological distress. Importantly, the results showed that the most important predictors of psychological distress in mothers during the COVID-19 outbreak were school closures, household income, and the use of adaptive and maladaptive emotion regulation strategies. Conclusions The findings highlight the intersection of individual, familial, and environmental factors in mothers’ mental health during crises.
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46
Changes in mental distress among employees during the three years of the COVID-19 pandemic in Germany
Swaantje Casjens, Dirk Taeger, Thomas Brüning, Thomas Behrens
PLoS One Infectious Diseases, 4.05.2024
Tilføjet 4.05.2024
by Swaantje Casjens, Dirk Taeger, Thomas Brüning, Thomas Behrens Objectives The COVID-19 pandemic changed the future of work sustainably and led to a general increase in mental stress. A study conducted during the second and third pandemic wave with a retrospective survey of the first wave among 1,545 non-healthcare workers confirmed an increase in anxiety and depression symptoms and showed a correlation with the occupational SARS-CoV-2 infection risk. This online follow-up survey aims to examine changes in mental distress as the pandemic progressed in Germany and to identify factors influencing potential changes. Methods Longitudinal data from 260 subjects were available for this analysis. Mental distress related to anxiety and depression symptoms, assessed by the Patient Health Questionnaire-4 (PHQ-4), and occupational risk factors were solicited at the end of 2022 and retrospectively at the fifth wave. Categorized PHQ-4 scores were modelled with mixed ordinal regression models and presented with odds ratios (OR) and 95% confidence intervals (95% CI). Results A previous diagnosis of a depressive or anxiety disorder was a strong risk factor for severe symptoms (OR 3.49, 95% CI 1.71–7.11). The impact of occupational SARS-CoV-2 infection risk on mental distress was increased, albeit failing to reach the formal level of statistical significance (high risk OR 1.83, 95% CI 0.59–5.63; probable risk OR 1.72, 95% CI 0.93–3.15). Mental distress was more pronounced in those with a previous diagnosis of anxiety and depression. Confirmed occupational risk factors were protective measures against occupational SARS-CoV-2 infection perceived as inadequate, chronic work-related stress, overcommitment, reduced interactions with fellow-workers, and work-privacy conflicts. Conclusions The pandemic had a negative impact on anxiety and depression symptoms among the studied non-healthcare workers, particularly early in the pandemic, although this effect does not appear to be permanent. There are modifiable risk factors that can protect workers’ mental health, including strengthening social interactions among employees and reducing work-privacy conflicts.
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47
Critical COVID-19, Victivallaceae abundance, and celiac disease: A mediation Mendelian randomization study
Yuxin Zou, Manyi Pan, Tianyu Zhou, Lifeng Yan, Yuntian Chen, Junjie Yun, Zhihua Wang, Huaqi Guo, Kai Zhang, Weining Xiong
PLoS One Infectious Diseases, 4.05.2024
Tilføjet 4.05.2024
by Yuxin Zou, Manyi Pan, Tianyu Zhou, Lifeng Yan, Yuntian Chen, Junjie Yun, Zhihua Wang, Huaqi Guo, Kai Zhang, Weining Xiong Celiac disease exhibits a higher prevalence among patients with coronavirus disease 2019. However, the potential influence of COVID-19 on celiac disease remains uncertain. Considering the significant association between gut microbiota alterations, COVID-19 and celiac disease, the two-step Mendelian randomization method was employed to investigate the genetic causality between COVID-19 and celiac disease, with gut microbiota as the potential mediators. We employed the genome-wide association study to select genetic instrumental variables associated with the exposure. Subsequently, these variables were utilized to evaluate the impact of COVID-19 on the risk of celiac disease and its potential influence on gut microbiota. Employing a two-step Mendelian randomization approach enabled the examination of potential causal relationships, encompassing: 1) the effects of COVID-19 infection, hospitalized COVID-19 and critical COVID-19 on the risk of celiac disease; 2) the influence of gut microbiota on celiac disease; and 3) the mediating impact of the gut microbiota between COVID-19 and the risk of celiac disease. Our findings revealed a significant association between critical COVID-19 and an elevated risk of celiac disease (inverse variance weighted [IVW]: P = 0.035). Furthermore, we observed an inverse correlation between critical COVID-19 and the abundance of Victivallaceae (IVW: P = 0.045). Notably, an increased Victivallaceae abundance exhibits a protective effect against the risk of celiac disease (IVW: P = 0.016). In conclusion, our analysis provides genetic evidence supporting the causal connection between critical COVID-19 and lower Victivallaceae abundance, thereby increasing the risk of celiac disease.
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48
Burden of COVID-19 pandemic on tuberculosis hospitalisation patterns at a tertiary care hospital in Rajasthan, India: a retrospective analysis
Rajotiya, S., Mishra, S., Singh, A. K., Debnath, S., Raj, P., Singh, P., Bareth, H., Nakash, P., Sharma, A., Singh, M., Nathiya, D., Joshi, N., Tomar, B. S.
BMJ Open, 3.05.2024
Tilføjet 3.05.2024
ObjectiveThis study aimed to investigate the burden of the COVID-19 pandemic on tuberculosis (TB) trends, patient demographics, disease types and hospitalisation duration within the Respiratory Medicine Department over three distinct phases: pre-COVID-19, COVID-19 and post-COVID-19. DesignRetrospective analysis using electronic medical records of patients with TB admitted between June 2018 and June 2023 was done to explore the impact of COVID-19 on patients with TB. The study employed a meticulous segmentation into pre-COVID-19, COVID-19 and post-COVID-19 eras. SettingNational Institute of Medical Science Hospital in Jaipur, Rajasthan, India. Primary and secondary outcome measuresPrimary outcome includes patients admitted to the Respiratory Medicine Department of the hospital and secondary outcome involves the duration of hospital stay. ResultsThe study encompassed 1845 subjects across the three eras, revealing a reduction in TB incidence during the post-COVID-19 era compared with the pre-COVID-19 period (p
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49
Antigenicity assessment of SARS-CoV-2 saltation variant BA.2.87.1
Sijie YangYuanling YuFanchong JianAyijiang YisimayiWeiliang SongJingyi LiuPeng WangYanli XuJing WangXiao NiuLingling YuYao WangFei ShaoRonghua JinYouchun WangYunlong Caoa Biomedical Pioneering Innovation Center (BIOPIC), Peking University, Beijing, People’s Republic of Chinab Changping Laboratory, Beijing, People’s Republic of Chinac Peking-Tsinghua Center for Life Sciences, Tsinghua University, Beijing, People’s Republic of Chinad College of Chemistry and Molecular Engineering Peking University, Beijing, People’s Republic of Chinae School of Life Sciences, Peking University, Beijing, People’s Republic of Chinaf College of Future Technology Peking University, Beijing, People’s Republic of Chinag Beijing Ditan Hospital Capital Medical University, Beijing, People’s Republic of Chinah Institute of Medical Biology Chinese Academy of Medical Science & Peking Union Medical College, Kunming, People’s Republic of China
Emerg Microbes Infect, 3.05.2024
Tilføjet 3.05.2024
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Impact of Booster Vaccination Interval on SARS-CoV-2 Infection, Hospitalization, and Death
Dan-Yu Lin, Yangjianchen Xu, Yu Gu, Shadia K Sunny, Zack Moore, Donglin Zeng
International Journal of Infectious Diseases, 3.05.2024
Tilføjet 3.05.2024
Vaccination plays a very important role in preventing SARS-CoV-2 infection and severe Covid-19 disease. Primary vaccination was highly effective against infection, hospitalization, and death, but its effectiveness waned gradually over time and was further reduced by the emergence of new variants [1-4]. Booster vaccination restored some immunity, but the added protection declined rapidly over time, especially against newer variants [5-8]. Bivalent boosters were more effective than monovalent boosters, but their effectiveness also waned over time [9-10].
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