Search Results (1,741)

Background/Objectives: The rise in urinary tract infections caused by multidrug-resistant (MDR) bacteria presents a serious public health challenge across the Balkans, a region already burdened by aging populations, healthcare resource limitations, and fragmented antimicrobial surveillance systems. Methods: This review explores the epidemiology, risk factors, and consequences of MDR UTIs, particularly in the context of the COVID-19 pandemic, which significantly accelerated antimicrobial resistance (AMR) due to widespread, inappropriate antibiotic use. Results: The paper discusses region-specific data on resistance trends, highlights the gaps in diagnostic infrastructure, and evaluates emerging clinical strategies including antimicrobial stewardship (AMS), rapid diagnostic technologies, novel antibiotics, and non-antibiotic alternatives such as bacteriophage therapy and vaccines. Conclusions: Policy recommendations are provided to strengthen surveillance, promote evidence-based treatment, and ensure equitable access to diagnostic and therapeutic tools. A multidimensional and regionally coordinated response is essential to curb the MDR UTI burden and safeguard public health across the Balkans. Full article

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, spread rapidly across the globe in 2020, with most countries experiencing two distinct waves of infection. In Brazil, the second wave was marked by the emergence of the P.1 (Gamma) variant, which disproportionately affected younger individuals and was associated with increased mortality. This study aimed to evaluate the epidemiological profile and post mortem histopathological lung findings, correlate them with laboratory results, and compare the first and second waves of COVID-19. To investigate neutrophil extracellular traps (NETs), we performed immunohistochemistry for citrullinated histone H3 (cit-H3) and myeloperoxidase (MPO). Our cohort included patients who died in the intensive care unit (ICU) of a single center in southern Brazil. The study included 42 patients, 24 from the first wave and 18 from the second, who died between March 2020 and August 2021. Laboratory data included complete blood counts and D-dimer levels. Histopathological analyses were conducted using H&E-stained slides and reviewed independently by two blinded pathologists. MPO and cit-H3 immunohistochemistry were performed to evaluate NETs markers. All cases exhibited varying degrees of inflammation and diffuse alveolar damage (DAD), with frequent microvascular thrombi. Neutrophilic infiltration was significantly higher in the second wave. Additionally, cases with intense neutrophilic infiltration showed a stronger association with thrombosis. NETs were identified in 10 cases. No significant correlation was found between histopathological findings, NETs, and laboratory blood count results. The histopathological findings were consistent with those reported globally. The second wave of COVID-19 showed higher neutrophilic infiltrate in the lung tissue. Neutrophils play a key role in the inflammatory response and NET formation might indicate an increased risk of mortality. Further studies can consider NET-targeted therapies as potential strategies. Full article

Background: The COVID-19 pandemic exposed major structural deficiencies in global health governance, including stark inequities in vaccine access, intervention timing, and mortality outcomes. While economic resources played a role, the influence of governance performance remains insufficiently examined. This study addresses a significant gap by integrating governance metrics with pandemic response data to assess how governance quality, independent of income level, affected national outcomes. Although the Oxford COVID-19 Government Response Tracker (OxCGRT) dataset has been widely used to document policy responses, this study offers a novel contribution by linking these policy interventions with governance performance and evaluating their joint effect on health outcomes and vaccine equity. Methods: This mixed-methods study combines quantitative analysis of global datasets with a qualitative literature review. Quantitative data were mainly obtained from the Oxford COVID-19 Government Response Tracker (OxCGRT), the World Bank’s Worldwide Governance Indicators (WGIs), and World Bank/WHO databases. A governance performance index was constructed using two WGI components: Government Effectiveness and Regulatory Quality. Countries were grouped into high, medium, or low governance categories. Statistical tests included ANOVA, Kaplan Meier survival analysis, and multivariable OLS regression. The qualitative component reviewed 45 academic and institutional sources on governance performance during COVID-19. Results: Countries with high governance performance had earlier public health interventions, lower mortality, and broader vaccine coverage, independent of income level. Kaplan Meier analysis revealed faster school closures in these countries (p < 0.01). Multivariable regression showed governance remained a significant predictor after adjusting for income and health spending. Qualitative findings highlighted recurring weaknesses in legal enforceability, intergovernmental coordination, and global financing mechanisms. Conclusions: Governance performance had a decisive impact on pandemic outcomes. The COVID-19 crisis revealed the need for robust governance systems capable of responding to complex emergencies that extend beyond the health sector into institutional, economic, and social spheres. Full article

This study examined the role of Geographic Information Systems (GIS) in municipal responses to the COVID-19 pandemic in Israel. A structured survey of officials from 130 municipalities was conducted, with a focus on the 87 municipalities that utilized GIS. An Exploratory Factor Analysis (EFA) was performed on the survey data from these GIS-user municipalities to identify the underlying dimensions of GIS application during the crisis. The analysis revealed that municipal GIS engagement is not a monolithic activity but is composed of three distinct, reliable, and interpretable latent factors: (1) Strategic and Operational Integration, reflecting the deep embedding of GIS into core governance and decision-making; (2) Temporal Engagement, capturing the sustained use of the system over the timeline of the pandemic’s fourth wave; and (3) Logistical Site Coordination, representing the specialized use of GIS for managing testing and vaccination sites. These findings move beyond documenting individual GIS tasks to provide an empirical, data-driven framework of how geospatial technology was operationalized. This study underscores the multidimensional nature of GIS in a public health emergency and offers a structured understanding that can inform future crisis preparedness, training, and technology implementation strategies for municipal governments. Full article

Background: Pakistan reported its first case of COVID-19 in February 2020 and joined other countries in activating a national emergency response following the declaration of the COVID-19 pandemic by the World Health Organization (WHO). Playing a vital role in the early phase of the country’s response was the National Stop Transmission of Polio (NSTOP) program, a highly trained cadre of polio workers who ordinarily support polio eradication efforts in the country. Methods: We developed a reporting tool using Microsoft Excel that tracked the activities of NSTOP officers to support the COVID-19 response. All NSTOP officers submitted their activity reports fortnightly using this reporting tool. Each provincial NSTOP officer reviewed and compiled their respective officers’ reports and sent them to the federal NSTOP Team. We present a summary of the reports for the period from 1 March 2020 to 31 July 2020. Results: A total of 71 officers of the NSTOP program supported various aspects of Pakistan’s COVID-19 response, including coordination, detection and response activities, surveillance, quarantine/isolation management, training and orientation sessions for healthcare personnel, data analysis, community engagement, and risk communication. They successfully investigated 32,729 suspected COVID-19 cases, of which about one-third were confirmed cases, and facilitated the collection and dispatch of >57,000 samples from these cases. Conclusions: This report details NSTOP contributions to the early phase of the COVID-19 response in Pakistan, demonstrating the value of polio investments beyond eradicating the disease to encompass having a workforce that is ready to respond to emergent disease threats and outbreaks. Such a workforce could also play a role in strengthening the capacity of existing immunization systems to help improve routine vaccination coverage in resource-limited settings. Full article

Air pollution poses a significant threat to public health, particularly in urban and industrialized regions. This study investigates the relationship between air quality and the frequency of Emergency Medical Service (EMS) calls in the Małopolska Voivodeship of Poland between 2020 and 2023. Data from over 190 air quality sensors (PM₁₀) were spatially aggregated using both hexagonal grids and administrative boundaries, while EMS call records were filtered to focus on cardiovascular and respiratory incidents. During 2020–2023, a total of 305,142 EMS calls were analyzed, and months with PM₁₀ exceedances showed an average of 1.50 respiratory calls per 1000 residents compared to 1.19 in months without exceedances. Statistical analyses, including Kolmogorov-Smirnov tests and Pearson correlation, were applied to explore temporal and spatial associations. Results indicate a statistically significant increase in EMS calls during periods of elevated air pollution, with the strongest correlation observed for respiratory-related incidents. Comparative analyses between high- and low-pollution municipalities supported the observed relationships. Further analysis indicated that the COVID-19 pandemic may have partially confounded these associations, particularly for respiratory cases, though significant patterns remained even after accounting for pandemic peaks. While limitations related to data gaps and seasonal biases exist, the findings suggest that real-time air pollution data could inform better EMS resource allocation. This research highlights the potential of integrating environmental data into public health strategies to improve emergency response and reduce health risks in polluted regions. Full article

Cyclophilins (Cyps), a family of peptidyl-prolyl isomerases, play essential roles in the life cycle of coronaviruses by interacting with viral proteins and modulating host immune responses. In this systematic review, we examined cell culture, animal model, and clinical studies assessing the anti-viral efficacy of cyclosporine A (CsA, PubChem CID: 5284373) and its non-immunosuppressive derivatives against coronaviruses. CsA demonstrated robust anti-viral activity in vitro across a broad range of coronaviruses, including but not limited to HCoV-229E, SARS-CoV, MERS-CoV, and SARS-CoV-2, with potent EC₅₀ values in the low micromolar range. Non-immunosuppressive analogs such as Alisporivir and NIM811 exhibited similar inhibitory effects. In vivo, CsA treatment significantly reduced viral load, ameliorated lung pathology, and improved survival in coronavirus-infected animals. Clinical studies further indicated that CsA administration was associated with improved outcomes in COVID-19 patients, including reduced mortality and shorter hospital stays. Mechanistic studies revealed that CsA disrupts the formation of viral replication complexes, interferes with critical Cyp–viral protein interactions, and modulates innate immune signaling. These findings collectively demonstrate the therapeutic potential of cyclophilin inhibitors as broad-spectrum anti-virals against current and emerging coronaviruses. Full article

The COVID-19 pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), catalyzed unprecedented innovation in molecular diagnostics to address critical gaps in rapid pathogen detection. Over the past five years, CRISPR-based systems, isothermal amplification techniques, and portable biosensors have emerged as transformative tools for nucleic acid detection, offering improvements in speed, sensitivity, and point-of-care applicability compared to conventional PCR. While numerous reviews have cataloged the technical specifications of these platforms, a critical gap remains in understanding the strategic and economic hurdles to their real-world implementation. This review provides a forward-looking analysis of the feasibility, scalability, and economic benefits of integrating these next-generation technologies into future pandemic-response pipelines. We synthesize advances in coronavirus-specific diagnostic platforms and attempt to highlight the need for their implementation as a cost-saving measure during surges in clinical demand. We evaluate the feasibility of translating these technologies—particularly CRISPR-Cas integration with recombinase polymerase amplification (RPA)—into robust first-line diagnostic pipelines for novel viral threats. By analyzing the evolution of diagnostic strategies during the COVID-19 era, we aim to provide strategic insights and new directions for developing and deploying effective detection platforms to better confront future viral pandemics. Full article

This case report presents a unique constellation of symptoms—including dry eye disease, visual and general asthenia, sleep disturbances, and restless legs syndrome—in a patient with a recent history of coronavirus disease 2019 (COVID-19) infection. While these symptoms have individually been associated with either COVID-19 or long COVID, their concurrent presentation and the simultaneous, positive response across all manifestations to a combined therapeutic regimen have not been previously described in a single case. The patient demonstrated notable improvement in both ocular and systemic symptoms following a six-week treatment with topical tear substitutes and oral administration of melatonin, and a multivitamin supplement including B-complex vitamins, antioxidants, and neuroprotective agents (Colinplus Delta^®, Farmaplus Italia Srl, Via Giovanni Porzio 4, 80143 Napoli, Italy). This response suggests a possible shared pathophysiological mechanism underlying these manifestations, potentially involving post-viral neuroinflammation, immune dysregulation, oxidative stress, or autonomic dysfunction. This case report highlights the need for an increased awareness of the interconnected nature of ocular and neurological symptoms in long COVID and supports further research into non-invasive, multimodal treatment strategies for this emerging clinical spectrum. Full article

Background: Evidence on the humoral and cellular immune responses to SARS-CoV-2 following COVID-19 vaccination in older adults is warranted. Aims: To synthesize and analyze the current evidence on humoral and cellular immune responses to both standard and booster COVID-19 vaccination in individuals aged 60 years and older. Methods: Clinical trials and observational studies were included. Reviews, case series, letters to the editor, and similar publications were excluded. A selective literature search was conducted in the following databases: PubMed, Scopus, EMBASE, and Web of Science. The risk of bias and methodological quality of the included studies were assessed using the Newcastle–Ottawa Scale (NOS) and the Risk of Bias 2.0 (RoB 2) tool. Statistical analysis was conducted using Stata version 18 and Review Manager version 5.4.1. Results: Thirteen studies were included: eleven observational studies and two randomized clinical trials, evaluating humoral and cellular immune responses in 782 older adults. Messenger RNA vaccines were the most administered, particularly Pfizer-BioNTech (76.9%) and Moderna mRNA-1273 (23%). In most cases, immune responses were assessed after the second dose and booster doses. Most studies (61.5%) reported increased IgG titers specific to the SARS-CoV-2 Spike protein, while 23.1% reported a decrease. Regarding cellular immunity, 46.2% of the studies reported low interferon-gamma (IFN-γ) levels post-vaccination, whereas 38.5% showed increases. These findings highlight the need for tailored vaccination strategies to address emerging variants, particularly in vulnerable populations such as older adults. Conclusions: In older adults receiving COVID-19 vaccination, humoral immunity tends to increase, whereas cellular responses are frequently diminished, reflecting age-related immunosenescence that may limit the durability and breadth of protection following vaccination in older adults. Full article

Solid organ transplant recipients (SOTRs) are at high risk of severe coronavirus disease 2019 (COVID-19), therefore early treatment of mild infections is crucial to prevent increased morbidity and mortality. The effectiveness of early treatment in SOTRs has yet to be fully characterized due to the emergence of new SARS-CoV-2 variants and to COVID-19 vaccination implementation. The aim of this single-center retrospective study is to evaluate the outcomes, safety and impact on SARS-CoV-2 viral load kinetics of COVID-19 early treatment in SOTRs. The study includes 80 SOTRs with a laboratory-confirmed diagnosis of symptomatic SARS-CoV-2 infection enrolled between January and October 2022 and treated with either monoclonal antibodies or antivirals. All patients received COVID-19 vaccination and 68.8% of them showed detectable levels of anti-spike (S) antibodies. The occurrence of clinical events (hospitalization, intensive care unit admission, or death) was assessed within 30 days after treatment initiation. The quantification of SARS-CoV-2 viral load were performed at baseline and at day-7. The rate of hospitalization was 2.5% [0.3–9%] and no deaths occurred. All patients completed treatment with no serious adverse events. Median viral load decrease was 0.48 [0.26–0.69] log₂ cycle threshold (ct) values, with no significant differences between SOTRs treated with monoclonal antibodies and those treated with antivirals. Viral load decrease was significantly associated with positive anti-s serology at baseline ($\beta$ = 0.196, p = 0.01), number of days between symptom onset and treatment ($\beta$ = 0.05, p = 0.03) and the number of comorbidities ($\beta$ = −0.05, p = 0.03). We provide evidence of real-world effectiveness of early therapy in SOTRs infected with SARS-CoV-2 and demonstrate the relevant role of humoral response to vaccination in enhancing early viral load decay during treatment. Full article

Background/Objectives: As COVID-19 policies shift from government mandates to individual responsibility, understanding how voluntary protective behaviors shape social interactions remains a public health priority. This study examines the association between voluntary mask wearing and interpersonal distance (IPD) preferences in a post-mandate context, focusing on Taiwan, where mask wearing continues to be culturally prevalent. Methods: One hundred university students (50 males, 50 females) in Taiwan completed an online IPD simulation task. Participants adjusted the distance of a virtual avatar in response to targets that varied by gender and mask status. Mask-wearing status upon arrival was recorded naturally, without manipulation. A four-way ANOVA tested the effects of participant gender, participant mask wearing, target gender, and target mask wearing on the preferred IPD. Results: Voluntary mask wearing was more common among female participants (72%) than males (44%). Mask-wearing individuals maintained significantly greater IPDs, suggesting heightened risk perception, whereas masked targets elicited smaller IPDs, possibly due to social signaling of safety. Gender differences emerged in both protective behavior and spatial preferences, with females showing stronger associations between mask use and distancing behavior. Conclusions: These findings offer actionable insights into how voluntary behavioral adaptations continue to shape spatial interaction norms after mandates are lifted. The integration of real-time simulation and statistical modeling highlights the potential of digital behavioral tools to support culturally adaptive, person-centered public health strategies. Full article

In recent years, Italy has experienced a significant increase in violence against healthcare workers, mirroring a global trend. Manifesting as verbal, physical, psychological, and material aggression, this phenomenon endangers both personnel safety and the foundational principles of the National Health Service (SSN) as outlined in Article 32 of the Italian Constitution. The escalation—most acute in emergency departments, psychiatric units, inpatient wards, and community services—affects a broad spectrum of professionals, compromising care quality and institutional integrity. Data from the FNOMCeO-CENSIS Report 2023–2024 reveal over 18,000 reported incidents in 2024, with verbal assaults disproportionately affecting female nursing staff. The COVID-19 pandemic further exacerbated systemic vulnerabilities, heightening user dissatisfaction and psychological strain among healthcare providers. In response, legislative actions—such as Law No. 113/2020 and Decree-Law No. 137/2024—aim to strengthen prevention, monitoring, and penal measures. This article examines legal, institutional, and organizational responses, including on-the-ground and hospital-based strategies to mitigate violence. Adopting a multidisciplinary perspective, it analyzes recent policy developments, regional dynamics, and victim-perpetrator profiles, arguing that safeguarding healthcare environments is both a public security priority and an ethical imperative essential to preserving the dignity of care work and the resilience of the health system. Full article

Background: The coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has had a profound impact on global health, extending beyond pulmonary complications. Cardiovascular involvement in COVID-19 is multifactorial and may be influenced by viral load, inflammatory response, and pre-existing comorbidities. Discussion: Acute complications include myocardial injury, arrhythmias, acute coronary syndromes (ACS), heart failure, Takotsubo cardiomyopathy, myopericarditis, and cardiac arrest. Notably, atrial fibrillation (AF) emerges as a frequent arrhythmic complication, particularly among critically ill patients, and is associated with increased mortality. COVID-19-patients with concomitant ACS present more severe clinical profiles and higher rates of thrombotic events, including stent thrombosis. Cardiac arrest predominantly presents with non-shockable rhythms and is associated with dismal outcomes. COVID-19 also exacerbates heart failure, both by aggravating existing cardiac dysfunction or by precipitating de novo heart failure. Takotsubo cardiomyopathy and myocarditis, although less frequent, have been reported and are often underdiagnosed due to subtle clinical presentations. Right ventricular dysfunction, linked to pulmonary involvement, has emerged as a key prognostic marker. Post-COVID-19 syndrome include persistent cardiac abnormalities such as reduced ventricular function and myocardial inflammation. Cardiac magnetic resonance imaging and strain echocardiography have proven useful in identifying subclinical cardiac involvement. Conclusions: Early recognition and monitoring of cardiovascular complications are crucial for improving outcomes in patients affected by COVID-19. This review summarizes current evidence regarding cardiovascular manifestations associated with COVID-19. Full article

Sex-based immunological differences significantly influence the outcome of vaccination, yet the molecular mediators underpinning these differences remain largely elusive. MicroRNAs (miRNAs), key post-transcriptional regulators of gene expression, have emerged as critical modulators of innate and adaptive immune responses. In this study, we investigated the expression profile of selected circulating miRNAs as potential biomarkers of sex-specific humoral responses to the mRNA COVID-19 vaccine in a cohort of health care workers. Plasma samples were collected longitudinally at a defined time point (average 71 days) post-vaccination and analyzed using RT-qPCR to quantify a panel of immune-relevant miRNAs. Anti-spike (anti-S) IgG titers were measured by chemiluminescent immunoassays. Our results revealed sex-dependent differences in miRNA expression dynamics, with miR-221-3p and miR-148a-3p significantly overexpressed in vaccinated female HCWs and miR-155-5p overexpressed in vaccinated males. MiR-148a-3p showed a significant association with anti-S/RBD (RBD: receptor binding domain) IgG levels in a sex-specific manner. Bioinformatic analysis for miRNA targets indicated distinct regulatory networks and pathways involved in innate and adaptive immune responses, potentially underlying the differential immune activation observed between males and females. These findings support the utility of circulating miRNAs as minimally invasive biomarkers for monitoring and predicting sex-specific vaccine-induced immune responses and provide mechanistic insights that may inform tailored vaccination strategies. Full article