COVID

Background: Endocrine disturbances are increasingly recognized as components of long COVID, yet long-term data remain limited. This study evaluated the prevalence of dysglycemia and thyroid autoimmunity four years after SARS-CoV-2 infection in adults without previously known endocrine disease. Methods: We conducted a retrospective longitudinal 4-year evaluation of adults hospitalized for COVID-19 between 2020 and 2021. Of 1009 eligible patients without prior diabetes or thyroid disease, 96 completed a standardized 4-year post-infection evaluation. Acute-phase data included COVID-19 severity, admission glucose, inflammatory markers, imaging findings, and treatments. The 4-year evaluation comprised fasting plasma glucose, thyroid function tests, anti-thyroid antibodies (anti-TPO, anti-Tg), and thyroid ultrasonography. Baseline HbA1c, thyroid autoantibodies, and thyroid imaging were not available. Results: At four years post-infection, 27.1% of patients exhibited dysglycemia compatible with type 2 diabetes mellitus, 41.6% showed thyroid autoimmunity, and 15.6% presented with both conditions. Overall, 47.9% developed at least one endocrine alteration. Admission hyperglycemia strongly predicted long-term dysglycemia (OR 6.67; 95% CI: 1.45–30.58), and diabetes prevalence increased with acute disease severity. Thyroid autoimmunity was frequent but not associated with initial COVID-19 severity. Conclusions: Four years after SARS-CoV-2 infection, a substantial proportion of patients exhibited persistent metabolic and autoimmune alterations, supporting a long COVID immunometabolic phenotype. In the absence of baseline endocrine data, the reported findings reflect long-term endocrine alterations identified at the 4-year evaluation, with a potential role of SARS-CoV-2 infection. These findings highlight the importance of baseline metabolic and thyroid assessment—including HbA1c and thyroid autoantibodies—in hospitalized COVID-19 patients and underscore the need for structured long-term endocrine monitoring. Full article

Although self-administered antigen tests are widely available, anatomical knowledge of nasal anatomy in the general population is limited. Cerebrospinal fluid leakage has been reported in multiple cases following damage to the roof of the nasal cavity due to accidental penetration of the cribriform plate of the ethmoid bone. Methods: Images of anatomical prosections used for teaching in the Dissection Room of the Faculty of Medicine of the University of Barcelona were obtained to illustrate the viable pathway to the nasopharynx through the inferior meatus, below the inferior turbinate. Screenshots from publicly available videos produced by the author demonstrating perpendicular swab insertion were analyzed, and multiethnic illustrative images were taken from staff volunteers. Publicly available instructions for patients included in the first eight nasal antigen tests for self-diagnosis authorized in Spain in 2021 were reviewed. Results: Most of the initially authorized antigen tests (all but one) still recommended in 2025 a vertical swab insertion. However, successful insertion into the inferior meatus towards the nasopharynx can be achieved with a perpendicular approach. A schematic illustration for free use is provided. Conclusion: Swab instructions should indicate an insertion perpendicular to the face to access the inferior meatus safely and reduce the risk of injury to the ethmoidal cells. Full article

One of the challenges post-COVID-19 is reducing the negative impacts on quality of life, performance, and independence in activities of daily living. Assessing functional dependence in adults one year after acute infection can help to understand the long-term consequences, evaluate the impact on quality of life, plan rehabilitation and healthcare, identify the most vulnerable groups, measure the socioeconomic impact, and support public policies and clinical decisions. Objectives: The objectives of this study are as follows: (a) to assess the prevalence of functional dependence in Brazilian adults with COVID-19; (b) to analyze the association between the study variables; and (c) to determine the factors associated with functional dependence. Methods: This was an observational, cross-sectional study with 987 adults (18 to 59 years old) living in the State of Paraná (Brazil) hospitalized for COVID-19 between March and December 2020. Data were collected by telephone 12 months after the acute infection using an instrument to retrieve sociodemographic and health information, and a functional dependence scale to assess dependence before COVID-19 retrospectively (using participant recall information) and at the time of the interview. Data were analyzed using penalized logistic regression after imputing missing data. Data were analyzed using penalized logistic regression after imputing missing data. Results: Functional dependence after COVID-19 was 5.0% and was associated with low levels of education, not having a partner, living with someone, not owning a home, experiencing job changes, requiring care, obesity, smoking, multimorbidity, ICU admission in the acute phase, use of invasive ventilation, or having Long COVID. Individuals who required care or used invasive ventilation support were, respectively, 9.3 and 6.5 times more likely to develop dependence after COVID-19. Despite adjustment for multiple factors, the magnitude of the observed effects warrants cautious interpretation, as unmeasured or residual confounding effects may still be present. Sample recall bias due to collection after 12 months and the presence of the alpha variant without COVID-19 vaccination coverage may limit data generalization. Conclusions: The results highlight the need to emphasize the public health implications of identifying functional dependence. In this vein, it is necessary to implement preventive measures, identify and monitor more vulnerable groups, plan rehabilitation programs, and develop public health policies. Full article

Background and Purpose: Post-COVID-19 syndrome significantly impacts respiratory function and quality of life. Inspiratory muscle training (IMT) has been proposed as a potential intervention to improve respiratory muscle strength and overall recovery. This study aimed to evaluate the effects of IMT on respiratory muscle performance, lung function, functional capacity, sleep quality, and quality of life in individuals with post-COVID-19 syndrome. Methods: Nineteen individuals with post-COVID-19 syndrome were randomized into an IMT group (N = 10) or a sham group (N = 9). The IMT group performed eight weeks of training at 50% of maximal inspiratory pressure (MIP), while the sham group used a non-load device. Outcomes included MIP (cm H₂O), functional capacity (6MWT), lung function (spirometry), sleep quality (PSQI), and quality of life (SF-36). Results: The IMT group showed significant improvements in MIP (125.50 ± 22.50 vs. 93.67 ± 20.87 cm H₂O; p = 0.036; Cohen’s d = 0.50), PSQI (4.40 ± 2.50 vs. 9.00 ± 2.80; p = 0.011; Cohen’s d = 0.60), and SF-36 (p = 0.030). The IMT group also increased 6MWT distance by 58.36 ± 25.10 m. Conclusions: IMT significantly improved respiratory muscle strength, sleep quality, and quality of life in post-COVID-19 syndrome. These findings suggest that IMT may be an effective intervention, warranting further studies to confirm long-term benefits. Full article

Influenza is typically framed as an acute respiratory infection, yet accumulating evidence suggests that—like SARS-CoV-2—it may trigger persistent, multi-organ morbidity consistent with a post-acute infection syndrome (“long flu”). Leveraging the nationwide FinnGen registry infrastructure, we conducted a temporally stratified disease-wide association study (DWAS) to map antecedent risk factors and long-term sequelae following clinically diagnosed influenza and COVID-19. We assembled an exposed cohort comprising 9204 individuals with influenza (ICD-10 J09–J11) and 4258 individuals with COVID-19 (ICD-10 U072) recorded in specialist inpatient/outpatient care between 1998 and 2021, and an unexposed comparator cohort of 420,005 individuals with no recorded influenza or pneumonia (J09–J18) across their available medical history. Across harmonized clinical endpoints, we fitted age- and sex-adjusted Cox proportional hazards models and controlled for multiple testing using a stringent false discovery rate threshold (FDR-adjusted p < 0.001), further interrogating temporal persistence within 1-, 5-, and 15-year windows. The DWAS revealed that both infections are associated with broad, system-spanning disease signatures extending beyond the respiratory tract, including circulatory, neurological, metabolic, musculoskeletal, digestive, mental/behavioural, ocular, and oncologic endpoints. Predisposition analyses demonstrated that infection risk is concentrated in individuals with substantial pre-existing multimorbidity, most prominently cardiovascular disease, alongside cardiometabolic, respiratory, renal, neuropsychiatric, and inflammatory conditions. Post-infection analyses identified a durable burden of incident multi-system morbidity after influenza, with particularly robust and persistent cardiovascular and neurological signatures—encompassing thromboembolic disease and major adverse cardiovascular outcomes, as well as migraine, neurodegenerative disorders, and depression—together with metabolic and renal sequelae that, in subsets, extended across multi-year horizons. Collectively, these longitudinal findings reframe influenza as a systemic event embedded within a chronic disease continuum, motivate recognition of “long flu” as a clinically meaningful post-viral risk landscape, and support intensified prevention and risk-stratified surveillance strategies alongside analogous efforts for long COVID. Full article

Numerous factors contributed to coronavirus 2019 (COVID-19) disease recovery and death rates. In many countries, socioeconomics, morbidities, the experience of symptoms and access to healthcare services are major contributors to recovery and death rates. A retrospective cohort study was conducted to determine the morbidity, mortality, survival probability, and risk factors associated with COVID-19 among children in the Free State province, South Africa. A total of 846 patients’ records were used in the study. Using SPSS version 28 software, survival probability was determined using Kaplan–Meier estimation curves and Cox regression was used to determine the effect of sociodemographics and clinical manifestation information on time of death. The COVID-19 mortality rate was 13.12% in our study. There were more female patients (60%) than male patients (40%). In total, 71 patients had two or more morbidities, while 414 patients were asymptomatic. Patients between 5 and 18 years old were at twice the risk of dying of COVID-19, and male children were at a higher risk as well. Having more than one symptom was also a risk for dying in this study. Severe COVID-19 is attributed to numerous factors, and these are closely associated with surrounding environments and public health systems. The findings are important for the clinical management of similar diseases and circumstances in the future. Full article

There is a paucity of evidence informing our understanding of how the COVID-19 pandemic affected pediatric trauma in Manitoba, Canada. The aim of this retrospective cohort study was to analyze the effect of the pandemic on pediatric trauma and its association with patients’ demographic characteristics. Pre-pandemic and pandemic patient cohorts were created, and the rates of these injuries were compared by patients’ sex, age, and area of residence. During the pre-pandemic period, ED presentations with an MSK or head injury were lower in patients from rural communities compared to urban communities (RR: 0.68, p < 0.001, RR: 0.51, p < 0.001). Hospitalizations with an MSK or head injury were higher in patients from rural communities (RR: 1.78, p < 0.001, RR: 1.14, p = 0.62). During the pandemic, MSK injury ED presentations (RR: 1.14, p = 0.037) and hospitalizations (RR: 1.78, p < 0.001) were higher in patients from rural communities. Patients from rural communities had a lower rate of head injury ED presentations (RR: 0.81, p < 0.001), but higher hospitalization rate (RR:1.96, p = 0.001). Differences in the rates of pediatric MSK and head injuries could be attributed to the limited healthcare resources in underserved rural communities. Efforts should be made to rectify these inequities to ensure fair access to healthcare for these patients. Full article

The COVID-19 pandemic exacerbated structural, social, economic, and racial inequalities affecting immigrant, refugee, and asylum-seeking men—vulnerable populations often overlooked in men’s health research. This study investigated the health conditions of immigrant, refugee, and asylum-seeking men during the COVID-19 pandemic. A scoping review was conducted following Joanna Briggs Institute guidance, and a qualitative lexical analysis (text-mining of standardized study syntheses) was performed in IRaMuTeQ using similarity analysis, descending hierarchical classification, and factorial correspondence analysis. We identified 93 studies published between 2020 and 2023 across 35 countries. The evidence highlighted vaccine hesitancy, high epidemiological risks (infection, hospitalization, and mortality), barriers to accessing services and information, socioeconomic vulnerabilities, psychological distress (e.g., anxiety and depression), and structural inequalities. Findings were synthesized into four integrated thematic categories emphasizing the role of gender constructs in help-seeking and gaps in governmental responses. Most studies focused on immigrants, with limited evidence on refugees and especially asylum seekers; therefore, conclusions should be interpreted cautiously for these groups. Overall, the review underscores the urgency of multisectoral interventions, universal access to healthcare regardless of migration status, culturally and linguistically appropriate outreach, and gender-sensitive primary care strategies to support inclusive and resilient health systems. Full article

The COVID-19 pandemic has highlighted the importance of rapid clinical decision-making to facilitate the efficient usage of healthcare resources. Over the past decade, machine learning (ML) has caused a tectonic shift in healthcare, empowering data-driven prediction and decision-making. Recent research demonstrates how ML was used to respond to the COVID-19 pandemic. This paper puts forth new computer-aided COVID-19 disease screening techniques using six classes of ML algorithms (including penalized logistic regression, random forest, artificial neural networks, and support vector machines) and evaluates their performance when applied to a real-world clinical dataset containing patients’ demographic information and vital indices (such as sex, ethnicity, age, pulse, pulse oximetry, respirations, temperature, BP systolic, BP diastolic, and BMI), as well as ICD-10 codes of existing comorbidities, as attributes to predict the risk of having COVID-19 for given patient(s). Variable importance metrics computed using a random forest model were used to reduce the number of important predictors to thirteen. Using prediction accuracy, sensitivity, specificity, and AUC as performance metrics, the performance of various ML methods was assessed, and the best model was selected. Our proposed model can be used in clinical settings as a rapid and accessible COVID-19 screening technique. Full article

This study aims to evaluate the reliability and minimal detectable change (MDC) of the 2 min marching test (2MMT) for cardiovascular response, as well as to compare its outcomes with those of the 6 min walk test (6MWT), in youth recovering from post-COVID-19 condition. Forty-four youth with post-COVID-19 condition underwent two assessment sessions, separated by five days, utilizing both the 6MWT and 2MMT to measure cardiorespiratory response parameters. Test–retest reliability was found to be excellent for the 6MWT (ICC = 0.83; MDC₉₅ = 8.06%) and good for the 2MMT (ICC = 0.78; MDC₉₅ = 15.61%) between initial and follow-up measurements. The 2MMT demonstrates good reliability and validity for assessing cardiovascular response in youth with post-COVID-19 condition. The reported MDC values provide clinically meaningful thresholds that enable clinicians to distinguish true changes in performance from measurement error. These findings support the use of the 2MMT as a practical tool for clinical assessment, providing preliminary guidance for interpreting changes in performance. However, longitudinal monitoring of patient progress was not directly assessed in this study. Full article

Background: In 2019, a new virus caused by SARS-CoV-2, called COVID-19, spread throughout the world, causing a pandemic state. As the pandemic progressed and cases continued to increase, safe vaccines were developed for the entire population. In Brazil, AstraZeneca^® (ChAdOx1-S) and Pfizer^® (BNT162b2) vaccines were among those administered to the population. Objectives: The objective of this study was to analyze whether immunoglobulin G (IgG) is produced for COVID-19 in individuals immunized with two doses of AstraZeneca (ChAdOx1-S) and Pfizer (BNT162b2) vaccines and to evaluate several parameters in order to understand how our bodies respond to this immunization. Methods: The study involved the participation of 120 individuals: 49 in the control group, 44 vaccinated with the AstraZeneca vaccine, and 27 the vaccinated with Pfizer vaccine. Results: Hematological, biochemical, inflammatory, and oxidant/antioxidant parameters and the production of IgG antibodies were analyzed. An increase in some inflammatory parameters was observed in vaccinated individuals, which may have been caused by an immune reaction after vaccination. In terms of hematological parameters, the changes caused by vaccination appear to be transient and quickly resolved after immunization. In terms of biochemical parameters, an increase in IgG antibodies was observed in the group vaccinated with the Pfizer^® vaccine; however, the AstraZeneca^® and control groups also produced IgG, although to a lesser extent. In terms of the remaining parameters, there was little change after vaccination. Regarding the levels of oxidants/antioxidants, it was observed that there was a compensation by antioxidants due to the increase in oxidant parameters, which may act as corrective mechanism. Conclusions: Both the AstraZeneca^® and Pfizer^® vaccines induced anti-SARS-CoV-2 IgG production, accompanied by inflammatory, hematological, and oxidative changes. Full article

Headache is a common symptom during SARS-CoV-2 infection and may persist beyond three months. Both tension-type and migraine-like headaches have been described during SARS-CoV-2 infection and after immunization. The main objective was to characterize headache phenotype during SARS-CoV-2 infection and its relationship with headache recurrence following reinfection and COVID-19 vaccination in a cohort of healthcare professionals. Secondary aims included profiling primary headaches and identifying predictors of post-COVID-19 headache persistence. We included 109 participants (86.2% women, mean age 45.3 ± 2.5 years). During infection, 49.5% met ICHD-3 criteria for tension-type headache and 12.8% for migraine. Headache recurred in 62.5% after reinfection and 59.2% after vaccination. A primary-headache history was present in 77.9% of sampled patients (25.9% migraine, 47.1% tension-type). The COVID-19 headache phenotype typically mirrored patients’ previous headache type during reinfection and post-vaccination. Persistent headache beyond three months from SARS-CoV-2 infection occurred in 22.9% and was associated with fibromyalgia and obesity. These findings suggest that COVID-19-related headache often mirrors the patient’s pre-existing primary headache and tends to recur with the same phenotype following reinfection or vaccination. Full article

Vulnerable populations experience higher mortality and readmission after hospital discharge. We sought to evaluate the impact of the Transitions Of Care Bundle (TOCB™) on COVID-19 patient outcomes post-discharge compared to a control cohort. This retrospective study used electronic health record data collected for 243 COVID-19 patients (65 TOCB™, 178 control) during the initial pandemic months at a large academic facility in Northeast New Jersey (NJ). Data included demographics, comorbidities, readmissions, mortality, and payor. The TOCB™ cohort had proportionally more Hispanic patients (56.92% vs. 48.3%, p = 0.0885). All TOCB™ patients were discharged home without needing additional services, compared to only 36% of the control group. The implementation of TOCB™ was associated with shorter hospital stays, a potential decrease in readmission rates, and fewer emergency department visits. These results imply that well-coordinated post-discharge services are linked to a diminished risk of mortality, possible hospital readmission, and other adverse health outcomes. Full article

Local Owner-Operated Retail Outlets (LOOROs) in India faced unprecedented disruption during the COVID-19 pandemic, with digital transformation emerging as both a challenge and an opportunity. The growing dominance of larger online and offline competitors, who swiftly adopted digital payments, posed a threat to traditional business models of these small neighborhood retailers. This study employs the Stimulus–Organism–Response (S-O-R) framework to examine the antecedents shaping LOORO owners’ attitudes toward digital payment practices and how these attitudes influence their intention and actual adoption. A survey of 175 LOOROs in Navi Mumbai was analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). The findings revealed that resource availability and customer care significantly influenced adoption, whereas competitor and customer pressure had little effect. Overall, LOORO owners demonstrated a positive outlook toward integrating digital payment systems, indicating their adaptive capacity to navigate the digital shift accelerated by the COVID-19 pandemic. Full article

COVID-19 in newborns presents a multifaceted clinical spectrum, with the potential for severe outcomes. This study aimed to evaluate the clinical evolution and hospital outcomes of neonates with a molecular diagnosis of COVID-19. A case-control study was conducted in a public referral maternity hospital for high-risk pregnancies. Two controls were selected for each case, matched by sex and gestational age. Variables related to birth data, symptoms, and clinical progression were collected from medical records and analyzed statistically, with crude and adjusted relative risks calculated using Poisson regression with robust standard errors. A total of 25 neonates with confirmed SARS-CoV-2 infection were identified among 875 newborns. Compared with controls, infected neonates had a longer hospital stay (median of 19 days vs. 8 days; p < 0.001) and higher readmission rates (16% vs. 0%; p = 0.03). After adjusting for potential confounders, COVID-19 infection was associated with a 2.41-fold higher risk of neonatal death (95% CI: 1.24–4.67; p = 0.009). No evidence of vertical transmission was found. These findings suggest that neonates with COVID-19 may experience longer hospitalizations and an adjusted higher risk of mortality, emphasizing the need for vigilant surveillance and supportive care. However, given the observational design of the study, these results indicate associations rather than causal relationships. Understanding the clinical behavior of COVID-19 in this population—characterized by inherently low immunity—and recognizing its interaction with other neonatal conditions are essential for improving hospital management and outcomes. Full article

Background: Several genes and genomic regions have been implicated in COVID-19 susceptibility and severity, but their clinical relevance remains uncertain. We comprehensively assessed both copy number variants (CNVs) and single-nucleotide variants (SNVs) disrupting genes implicated in COVID-19 in a Swedish cohort of ICU-treated COVID-19 patients with detailed phenotype data. Methods: Patients (n = 301) with severe COVID-19 treated in intensive care units (ICU) between March 2020 and January 2021 at two large Swedish university hospitals were included. Whole exome sequencing (WES) was performed to identify both large copy number variations (CNVs) and single-nucleotide variants (SNVs), including small indels, using the Genome Analysis Toolkit (GATK) pipelines. We focused our analyses on variants disrupting coding genes implicated in severe COVID-19, but also assessed variants known to cause human disease. Results: We identified 11 rare CNVs and several SNVs potentially linked to severe COVID-19. Patients carrying a CNV spanning a COVID-19-implicated gene had higher levels of the heart failure marker NT-proBNP (median 4440 [1558–8160] vs. 1170 [329–3152], p = 0.017), worse renal function at ICU admission (p = 0.0026), and a higher need for continuous renal replacement therapy (CRRT) (28% vs. 10%, p = 0.045) compared to patients without a potentially damaging CNV. Conclusions: Although patients with a potentially damaging CNV or SNV exhibited some differences in cardiac and renal markers, our findings do not support broad genetic screening as a predictive tool for COVID-19 severity. Full article

It is imperative that society becomes aware of ergonomic risks, not only in an occupational place but also in everyday contexts where they can go unnoticed, such as the educational sector, and in the specific case of students. To identify this risk, an ergonomic assessment was conducted on students in Mexico during remote learning due to COVID-19. To this end, a survey was applied, and the ROSA (Rapid Office Strain Assessment) method was used. According to the survey results, the students reported adopting inappropriate postures during online classes and suffering from musculoskeletal pains. Furthermore, they showed a strong interest in learning about ergonomics and improving their postures. In addition, the application of the ROSA method yielded a significant result 60% of the evaluated students are at high or very high ergonomic risk. Regardless of their profession, ergonomics should be integrated as part of educational programs. This measure would help prevent musculoskeletal disorders once students transition into their respective work environments. Full article

Posterior Reversible Encephalopathy Syndrome (PRES) is a rare but potentially reversible neurological manifestation associated with Multisystem Inflammatory Syndrome in Children (MIS-C). We report an eight-year-old boy who developed PRES secondary to MIS-C following asymptomatic SARS-CoV-2 exposure. The patient presented with fever, seizures, decreased consciousness, and visual disturbances. MRI revealed characteristic bilateral parieto-occipital and posterior temporal cortical–subcortical hyperintensities, while CT scans were normal. The patient achieved full neurological recovery with corticosteroid therapy, blood pressure control, and supportive management. This case underscores the importance of early MRI in detecting PRES when clinical or CT findings are inconclusive, emphasizing the need for heightened awareness among pediatric clinicians to prevent irreversible neurological sequelae. Full article

Background: According to the National Institute for Health and Care Excellence (NICE), long COVID refers to symptoms persisting for four weeks or more after acute infection, with over 100 identified, including fatigue, cognitive dysfunction, and breathlessness. Women aged 45–54 are disproportionately affected, overlapping with the typical age for perimenopause and menopause. This scoping review aimed to provide an overview of existing research on the intersection between long COVID and the menopausal transition. Methods: Five database (CINAHL ultimate, MEDLINE, ScienceDirect, Cochrane, and Scopus) searches yielded 387 articles; after removing 40 duplicates and screening 347 titles and abstracts, fourteen studies were reviewed in full, with seven meeting the inclusion criteria (examined both long COVID and menopause in their scope and are written in English language). Results: This scoping review identified a significant symptomatic overlap between long COVID and menopause reported by participants, particularly fatigue, cognitive difficulties, mood changes, and sleep disturbances. Preliminary evidence also suggests that hormonal fluctuations may influence symptom severity, though biological mechanisms remain insufficiently understood. Methodological limitations restrict generalisability, underscoring the need for longitudinal symptom tracking, diverse samples, and biomarker-informed studies. Recognising the intersection of long COVID and menopausal transition is essential for improving assessment, management, and targeted care for affected women. Full article