Search Results (14,296)

Objectives: This study aimed to assess the impact of the COVID-19 pandemic on the epidemiology, microbiology, clinical presentation, management, and outcomes of infective endocarditis (IE). Methods: A retrospective cohort study was conducted, including 100 adult patients with definite IE diagnosed between January 2020 and December 2025 at a Romanian tertiary care centre. Patients were stratified by year of admission into pandemic (2020–2022) and post-pandemic (2023–2025) groups. Results: Among the 100 patients (47 in the pandemic period and 53 in the post-pandemic period), the time from symptom onset to diagnosis was significantly shorter in the post-pandemic period (median of 24 days versus 40 days; p < 0.01). We observed changes in the microbiological profile. The proportion of staphylococcal IE was lower, while the proportions of enterococcal and streptococcal IE were slightly higher in the post-pandemic period. In-hospital mortality decreased significantly from 51.1% to 24.5% (p = 0.006). Embolic events were more frequent in the post-pandemic period (62.3% vs. 39.1%; p = 0.022). Vegetation size was associated with embolic risk (OR: 1.05 per mm; p < 0.01). Pandemic-period admission (aOR 3.11; p = 0.020) and sepsis (aOR 11.30; p = 0.006) were independently associated with higher in-hospital mortality. Conclusions: The COVID-19 pandemic was associated with delayed presentation and worse outcomes in IE. Post-pandemic improvements likely reflect healthcare system adaptation and earlier diagnosis. Microbiological aetiology remains a key determinant of prognosis. Full article

The COVID-19 pandemic led to a dramatic increase in healthcare-associated infections and antimicrobial resistance, particularly in intensive care units (ICUs). The aim of this study was to provide a comprehensive genomic characterisation of all clinically significant opportunistic pathogens (OPs) isolated from patients and the hospital environment in COVID-19 ICUs, and to use these data to reconstruct transmission pathways, identify reservoirs, and assess the molecular mechanisms of antimicrobial resistance and virulence. Whole-genome sequencing (WGS) was performed on 175 isolates isolated from patients and the hospital environment (including personal protective equipment, PPE) between 2021 and 2023. The species collection included nine OP species. Bioinformatic analysis included multilocus sequence typing, core genome single-nucleotide polymorphism analysis, phylogenetic reconstruction, and in silico detection of resistance and virulence genes and plasmid replicons. High-risk multidrug-resistant (MDR) clones were identified among Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli, and Staphylococcus aureus. Core genome SNP analysis confirmed direct transmission of K. pneumoniae between patients and healthcare worker medical gloves. PPE was identified as a major reservoir, accounting for 68.4% of environmental isolates. The study demonstrates the power of WGS for high-resolution epidemiological surveillance, confirms the critical role of contaminated PPE in nosocomial transmission, and highlights the dominance of internationally spreading MDR clones in COVID-19 ICUs. Full article

Introduction: Long COVID-19 is a complex and multifaceted condition characterized by persistent and fluctuating symptoms extending beyond the acute phase of infection. Aim: To explore the health and support experiences of the Spanish population living with long COVID-19. Methodology: A qualitative study with an interpretative phenomenological approach was used. Semi-structured interviews were conducted over 10 months (2023–2024) across 17 Spanish provinces. The sample included 36 participants. Results: Participants reported persistent and fluctuating symptoms that severely limited daily functioning and generated anxiety, depression, and post-traumatic distress. Chronic fatigue and cognitive impairment affected social participation and work performance, frequently leading to absenteeism and job loss. Delayed diagnosis limited professional knowledge, and perceived lack of credibility contributed to dissatisfaction with healthcare services. Family members and patient associations were key sources of emotional and practical support. Conclusions: Long COVID-19 has a multidimensional impact that requires a comprehensive and multidisciplinary approach. Participants’ narratives reveal how underestimation of symptoms, delayed diagnosis, social stigma, limited healthcare and social support, additional family burdens, and disrupted work and social routines create complexity in care and challenge existing health and economic systems. Full article

Background/Objectives: Although SARS-CoV-2 infection is usually mild in children, some develop severe respiratory disease (RD) or multisystem inflammatory syndrome in children (MIS-C). We evaluated long-term respiratory symptoms, pulmonary function, and cardiopulmonary exercise performance in children recovering from SARS-CoV-2-related RD and MIS-C. Methods: This single-center prospective observational study included children hospitalized for SARS-CoV-2-related RD or MIS-C. Pulmonary function tests (PFTs) and cardiopulmonary exercise testing (CPET) were performed at a mean follow-up of 22.8 ± 9.8 months after hospitalization and compared between groups. Results: Forty-two children (25 RD, 17 MIS-C) were included. Persistent post-COVID symptoms were reported by 38.1% of participants and were more frequent in the RD group (56.0% vs. 11.8%; p < 0.01), with fatigue being the predominant symptom (p = 0.02). Pulmonary function and CPET parameters were comparable between groups, with no evidence of clinically significant ventilatory limitation or impaired aerobic capacity. VO₂peak did not differ between groups. Multivariable regression identified the breathing reserve index and OUES normalized to body weight as strong positive predictors of aerobic capacity in both groups. Despite differences in follow-up duration, stratified analyses using a 24-month cut-off showed comparable physiological findings. Conclusions: Children demonstrated preserved pulmonary function and exercise capacity nearly two years after hospitalization for severe SARS-CoV-2-related RD or MIS-C. Despite these favorable objective findings, subjective symptoms persisted in a substantial subset of patients, particularly those recovering from RD, suggesting that symptom resolution may lag behind objective physiological recovery. OUES normalized to body weight and the breathing reserve index may serve as complementary markers of aerobic capacity. Full article

The COVID-19 pandemic shifted pediatric infection epidemiology from bacterial toward viral predominance as public health measures relaxed. To determine how hospital antibiotic prescribing adapted, antimicrobial consumption was characterized and linked to underlying pathogen type. Antibiotic use was retrospectively analyzed among 567 children admitted with a positive microbiological finding to the pediatric ward of a tertiary hospital in Split, Croatia, during the first quarters of 2021–2024. Consumption was quantified using Days of Therapy (DOT), Length of Therapy (LOT), and Days of Antibiotic Spectrum Coverage (DASC) per 1000 patient-days (PD). Antibiotics were grouped by the WHO Access/Watch/Reserve (AWaRe) classification and linked to discharge diagnosis and pathogen type. The proportion of children receiving antibiotics rose from 60.5% (26/43) in 2021 to 71.4% (130/182) in 2024, with the cohort shifting toward younger infants and virally driven diagnoses. DOT, DASC, and DOT/LOT peaked in 2022 (DOT 2164/1000 PD, DOT/LOT 2.2) before settling near 1400/1000 PD, with mean per-day spectrum (DASC/DOT) declining modestly (7.7 to 6.8). Watch-group antibiotics dominated throughout (~80%), with Access contribution of ~20% and Reserve antibiotic use negligible. Ceftriaxone usage rose fivefold (150 to 755 DOT/1000 PD) to become the leading agent. Ceftriaxone and azithromycin were administered more often to children with viral than bacterial infections (respiratory syncytial virus being most common), whereas vancomycin and meropenem were tied to bacterial isolates. These findings identify a high-yield stewardship target and underscore the value of multi-metric, pathogen-aware surveillance. Full article

Background/Objectives: Comparisons of abdominal Surgical-Site Infection (SSI) rates during COVID-19 often treat recorded incidence as a direct measure of biological risk, although the pandemic altered operative volume and case mix, prevention practices, and post-discharge detection. This review examines when reported SSI changes are interpretable. Methods: We conducted a critical narrative review, informed by SANRA and critical interpretive synthesis, of MEDLINE/PubMed, Embase, Scopus, and Europe PMC (January 2018–25 June 2026). Comparative SSI studies formed the core evidence set, supported by contextual studies on emergency presentation, biological risk, prevention, and surveillance. Results: Studies reported lower, unchanged, non-monotonic, and higher SSI rates. These differences became more coherent when the recorded rate was separated into operative composition, true infection probability, and detection probability. No core study measured all domains required to isolate a biological pandemic effect. Evidence from acute pancreatitis and abdominal trauma showed that disease severity, care access, inflammatory status, and prognostic relationships varied with health-system context. Conclusions: We propose the Surgical-Site Infection Signal-Validity Framework (SSI-SVF). It classifies findings as probable true improvement, apparent improvement, masked deterioration, mixed deterioration, or indeterminate and requires joint assessment of operative composition, true infection risk, and detection probability before interpreting a calendar-period change as altered surgical safety. Full article

The mitigation measures adopted to reduce the spread of COVID-19 have not only impacted the transmission of respiratory infections but also other infectious diseases. In this study, we explored the effect of the pandemic on the epidemiology of Central Nervous System (CNS) infections by conducting a retrospective analysis of diagnostic data obtained from cerebrospinal fluids (CSFs) collected before, during, and after the pandemic from patients with acute-suspected neuro-infectious syndrome. The samples were analyzed using a meningitis/encephalitis molecular syndromic panel. A total of 4203 CSFs were split into three groups: pre-pandemic (August 2018–February 2020), pandemic (March 2020–March 2022) and post-pandemic (April 2022–March 2024). Each pathogen was statistically assessed individually, comparing one group vs. another. Results showed that viral pathogens were the most frequently detected across all groups; however, Streptococcus pneumoniae was the single most identified pathogen. Comparison of the pre-pandemic and pandemic groups by statistical analysis showed a significant reduction in neuro-infections caused by enterovirus, S. pneumoniae and N. meningitidis, while the other pathogens were not affected. In conclusion, a reduction in CNS infections caused by respiratory and close-contact-transmitted pathogens, including both viral and bacterial agents, was observed during the period when COVID-19 containment measures were in effect. Full article

India has one of the highest public health burdens attributable to air pollution globally. Despite national air quality regulations and control policies, improvements in air quality have been limited, restricting opportunities to evaluate the health benefits of cleaner air under real-world conditions. COVID-19 lockdowns substantially reduced air pollution in India’s megacities, creating a natural experiment for assessing pollution-attributable health benefits. Using ambient PM_2.5 concentration data from United States Embassy and Consulate monitors in Chennai, Hyderabad, Kolkata, Mumbai, and New Delhi during the 2020 and 2021 lockdowns, and World Health Organization AirQ+ software, we estimated the short- and long-term health benefits of maintaining lockdown-related improvements in air quality. PM_2.5 reductions ranging from 28–77% during the first lockdown, if sustained long term, would lead to about 42,778 fewer premature deaths in the short term and 132,000 fewer annual avoidable deaths from all causes under the modeled scenario across the five cities. We also estimated annual reductions of 11,100 deaths from chronic obstructive pulmonary disease, 3900 from lung cancer, 5500 from ischaemic heart disease, 3900 from stroke, and 1240 from acute lower respiratory infection. These findings support stronger air quality standards, emission controls, and policy enforcement to reduce air pollution-related mortality in Indian megacities. Full article

Background: Vaccine hesitancy is a global challenge affecting workplaces and academic institutions. Despite efforts, low vaccination rates persist in South Africa, increasing the risks associated with pathogen exposure. This study assessed the knowledge, attitudes, and perceptions (KAPs) of healthcare workers (HCWs) and students at a Nursing College regarding voluntary and mandatory COVID-19 vaccination. Methods: A quantitative cross-sectional study was conducted using a structured, self-administered electronic questionnaire. All eligible nursing students and staff at the participating Nursing College were invited to participate. Of the 504 eligible individuals, 372 completed the questionnaire, corresponding to a response rate of 73.8%. Data were analyzed using IBM SPSS Statistics version 30.0. Logistic regression and Mann–Whitney U tests were used to assess associations and differences between groups, with statistical significance set at p < 0.05. Results: Most respondents were female (302, 81.0%) and single (252, 67.9%). The age group 26 to 40 was most prominent (144, 38.8%). Only 42.2% of respondents (n = 157) were fully immunized with no boosters. Student nurses dominated (344, 92.5%), with 226 (60.9%) having no COVID-19 infections and 198 (72.0%) voluntarily receiving the vaccine. Occupation (p = 0.030) and age group (p = 0.027) were independently associated with reporting voluntary COVID-19 vaccination. Age was also associated with respondents’ attitudes and perceptions of the COVID-19 vaccine (p < 0.001) as well as their understanding of the vaccine (p = 0.002). Conclusions: Occupation and age group were independently associated with the reported basis on which COVID-19 vaccination was received (voluntary versus mandatory). Targeted communication and educational strategies addressing these factors may improve vaccine acceptance and preparedness for future outbreaks. Full article

This work constructs, analyzes and simulates a new general SIR epidemiological model for the spread of a generic long-time disease, in which the coefficients of infectivity and death rate are system variables. Diseases, such as COVID-19, have demonstrated clearly that infectivity and death rates can change over time, even for the same variant of the virus, due to vaccination, improved treatments, better analysis, better medications, etc. This motivates us to construct the SIR-ID model for a generic disease in which the rate coefficients are state variables as a part of the systems’s evolution in time. The model consists of a coupled system of five differential equations, where the equations for the infectivity and death rate have general source functions. The analysis shows the existence, positivity and boundedness of the solutions. A discussion of the Endemic (EE) and Disease-Free (DFE) equilibria and their stability is provided. A bifurcation analysis of the DFE and EE is conducted, as well as a sensitivity analysis. Then, computer simulations depict two typical cases of dynamic behavior, one when the DFE is stable and attracting, and one in which the EE is stable and attracting. These also show the way the system approaches the steady states. Full article

Chronic hepatitis B and C are major causes of cirrhosis, hepatocellular carcinoma, and liver-related mortality worldwide. The genetic diversity of hepatitis B virus (HBV) and hepatitis C virus (HCV) influences disease progression, diagnosis, vaccine response, and antiviral treatment. Periods of healthcare disruption, such as the COVID-19 pandemic, reinforce the importance of molecular surveillance to monitor viral genotypes and clinically relevant mutations. This study described the distribution of HBV and HCV genotypes and mutations in Rio de Janeiro, Brazil, during the COVID-19 pandemic. A cross-sectional study included 25 patients (15 HBV and 10 HCV) recruited between 2020 and 2022. Viral nucleic acids were amplified and sequenced by Sanger methodology, and mutations were analyzed using the Geno2pheno platform. HBV genotype A predominated (67%), comprising subgenotypes A1 (40%) and A2 (27%), followed by the rare genotypes B1 (13%), F2 (13%), and G (7%). Among HCV-infected individuals, genotypes 1a (40%) and 1b (30%) predominated, followed by genotypes 4 (20%) and 2 (10%). HBV immune escape mutations (Y100C and T126S) and unusual insertions in the S and RT domains were identified. In HCV, the substitutions C316Y, C316N, and S282R were detected. These findings highlight the importance of molecular surveillance for detecting clinically relevant viral variants. Full article

Coronavirus disease 2019 (COVID-19) is increasingly recognized as a multisystem disorder associated with persistent metabolic complications extending beyond the acute phase of infection. Accumulating evidence suggests that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may disrupt glucose homeostasis through mechanisms involving pancreatic β-cell dysfunction, insulin resistance, chronic inflammation, oxidative stress, mitochondrial dysfunction, and hypoxia-related signalling. This review summarizes current evidence regarding the molecular and cellular mechanisms linking SARS-CoV-2 infection to impaired insulin secretion and post-COVID metabolic disturbances. Particular emphasis is placed on the regulation of insulin secretion, β-cell compensation and failure, oxidative stress, inflammatory signalling, mitochondrial dysfunction, and the development of the post-COVID metabolic phenotype. Emerging evidence indicates that persistent metabolic abnormalities after COVID-19 may range from transient dysglycaemia to new-onset diabetes mellitus and metabolic syndrome. The review also discusses clinical implications, biomarkers, therapeutic perspectives, and unresolved questions regarding the reversibility of post-COVID β-cell dysfunction. A better understanding of the mechanisms underlying post-COVID metabolic dysfunction may improve risk stratification, facilitate early intervention, and support development of targeted therapeutic strategies aimed at preserving β-cell function and long-term metabolic health. Full article

The COVID-19 pandemic resulted in historically high levels of psychological distress. Significant age differences in distress were consistently observed, and they present an opportunity to identify the mechanisms driving the prosocial decision-making underlying pandemic mitigation behaviors. As predicted by the cascade model of individual and age differences in prosocial motivation, re-analyses of the data from two previous surveys revealed the positive role of prosocial motivation in pandemic decisions as well as the negative roles played by neuroticism, anxiety, and depression. Social distancing was altruistically motivated, as evidenced by its positive associations with both altruism and sympathy measures. Moreover, the increases in distancing with age and concern for close others suggests that distancing was not primarily driven by concerns regarding the personal consequences of infection. Multiple age-related positivity effects were observed in which concerns and risk assessments decreased with age. Concern for others decreased with age less than concerns for oneself, suggesting a possible basis for age-related increases in altruism. Taken together, these findings suggest theoretical linkages between the cascade model and socioemotional selectivity theory, linkages that may have implications for prosocial public health messaging. Full article

MicroRNAs (miRNAs) are key post-transcriptional regulators of gene expression and play a fundamental role in host response to viral infections. SARS-CoV-2 has been shown to dysregulate host miRNA expression, potentially as a mechanism to modulate cellular pathways for its own replication or to evade immune responses. However, evidence from the literature related to the specific miRNA landscape in SARS-CoV-2 infection is conflicting and unclear. We employed an integrative multi-model approach using human nasal lung epithelial cell lines and pulmonary organoids to map miRNA expression dynamics after SARS-CoV-2 infection. Data obtained from the CALU-3 miRNAome were successively validated in other two cellular models (hAEC and hLORG), and from this comparative analysis, two miRNAs, miR-141-3p and miR-33a-5p, were found to be significantly dysregulated. These miRNAs are involved in critical pathways, including cytokine-mediated signalling, apoptotic processes and epithelial cell junction integrity. High-throughput miRNA profiling was followed by functional enrichment analysis of their predicted targets to delineate affected biological pathways. By highlighting candidate miRNAs and regulatory pathways that may contribute to disease pathogenesis, we identified robust, infection-associated hallmarks across cell models, establishing a foundation for future therapeutic strategies for COVID-19 based on the development of miRNA-guided approaches. Full article

Long COVID (LC) is a heterogeneous post-infectious syndrome characterized by persistent symptoms, yet the biological basis underlying its interindividual variability remains poorly understood. Given the clinical overlap between LC and myalgic encephalomyelitis (ME), and prior demonstration that haptoglobin (Hp) phenotypes modulate symptom severity in ME, we investigated whether Hp phenotypes similarly stratify post-exertional cognitive dysfunction in LC. In this longitudinal observational study, 44 individuals with LC and 20 short-course COVID controls, who recovered rapidly from SARS-CoV-2 infection without persistent symptoms or sequelae, underwent Hp phenotyping alongside metabolomic and physiological profiling before and after a standardized 90 min passive post-exertional challenge. Hp phenotypes identified clinically distinct LC subgroups. Compared with Hp1-1 individuals, Hp2 allele carriers exhibited greater fatigue, poorer physical function, and more severe post-exertional symptoms. Immediately following the challenge, Hp2-2 participants with LC showed significant cognitive decline, whereas Hp1-1 individuals demonstrated cognitive resilience and more favorable longitudinal cognitive trajectories. This differential susceptibility was accompanied by higher post-exertional cerebral fractional tissue oxygen extraction in the right hemisphere in Hp1-1 individuals and by distinct metabolic signatures, with Hp2 allele carriers exhibiting lower post-exertional plasma concentrations of citric acid, isethionate, and glucosamine. Lower metabolite levels were associated with poorer cognitive performance. These findings support Hp phenotypes as promising candidate biomarkers for biological stratification in Long COVID, pending validation in larger independent cohorts. Full article