Search Results (6,998)

Background and Objectives: Convalescent plasma (CP) was widely used during the early phase of the COVID-19 pandemic; however, evidence regarding its clinical benefit has remained inconsistent. This study evaluated the associations of CP administration timing and the ELISA antibody level of the transfused unit with clinical outcomes among patients with COVID-19. Materials and Methods: This retrospective real-world cohort study included 272 adults with RT-PCR-confirmed COVID-19 who received a single CP unit at the University of Health Sciences Trabzon Kanuni Training and Research Hospital, Türkiye, between 1 April 2020 and 1 April 2021. At CP administration, 180 patients were hospitalized, and 92 were treated as outpatients; initial cohort assignment was retained throughout follow-up. Anti-SARS-CoV-2 IgG was assessed using the semi-quantitative Euroimmun ELISA, and exploratory low (0.00–0.99), medium (1.00–4.99), and high (≥5.00) categories were used. The primary outcome was 30-day all-cause mortality. Results: During follow-up, 18 of 92 outpatients (19.6%) required hospitalization. Thirty-day mortality was higher among hospitalized patients than among outpatients (39.4% vs. 1.1%; p < 0.001), reflecting major baseline clinical differences between the groups. Median ELISA indices did not differ significantly between hospitalized patients and outpatients [4.23 (IQR, 2.65–6.43) vs. 3.64 (IQR, 2.16–6.13); p = 0.308]. Among hospitalized patients, ELISA-index distributions were similar between survivors and non-survivors (p = 0.427), and the index was not associated with mortality when analyzed continuously after log2 transformation (OR per doubling, 0.89; 95% CI, 0.67–1.19; p = 0.425). The high-versus-medium category comparison was also non-significant (OR, 0.88; 95% CI, 0.48–1.62; p = 0.757), as was the timing-by-ELISA interaction (p = 0.074). Conclusions: In this CP-treated cohort, the ELISA index of the transfused unit was not independently associated with 30-day mortality. The exploratory subgroup findings do not establish CP effectiveness or superiority of a particular timing or antibody-level category. Full article

Background: Interrupted time-series studies have not shown a consistent increase in suicide mortality during COVID-19, but civil mortality registries cannot ascertain SARS-CoV-2 infection individually. We evaluated pandemic-related change in suicide mortality and the feasibility of integrating infection ascertainment into medico-legal surveillance. Methods: We analysed 395 suicide deaths in Galați and Brăila counties, Romania (January 2018–December 2024), where mandatory forensic autopsy ensures exhaustive ascertainment. The pre-specified primary analysis was seasonally adjusted segmented Poisson regression in January 2018–December 2022 with an onset in March 2020; the period 2023–2024 was excluded as incompletely ascertained. Changepoint detection and unadjusted period comparisons were descriptive. Infection was classified as laboratory-confirmed (documented ante-mortem RT-PCR) or possible/probable (compatible autopsy findings); no post-mortem testing was performed. Results: The level change at onset was not significant (IRR 1.29, 95% CI 0.80–2.08; p = 0.302), nor was the slope change (IRR 1.01, 95% CI 0.98–1.04; p = 0.639); power was 80% only against IRR ≥ 1.98. Posterior probabilities were 0.85 for any increase and 0.035 for a doubling. The unadjusted comparison (6.00 vs. 4.62 deaths/month; IRR 1.30, 95% CI 1.04–1.63) was descriptive; no changepoint coincided with onset. Among 140 deaths in 2020–2021, 34 (24.3%) met ascertainment criteria, 21 (15.0%) laboratory-confirmed. Conclusions: The data exclude a doubling of suicide mortality but not a modest increase: a regional surveillance signal, not a causal finding. Infection ascertainment proved feasible within routine medico-legal investigation, yielding a reproducible framework for other registries, an Eastern European series for future meta-analyses, and a proof-of-concept for a standing forensic surveillance capacity adaptable to future epidemics. Full article

The occurrence of viral zoonotic spillover (the transmission of viruses from animals to humans) has attracted worldwide attention due to mounting concerns regarding viral threats such as avian influenza, Hendra, monkeypox, Nipah and bat coronaviruses. It is evident that these events deviate significantly from natural occurrences, being the conflation of ecological, environmental and social factors that are profoundly altering the boundaries between the animal and human domains. Consequently, in order to comprehend both the contemporary and prospective drivers of zoonotic viral spillover, a coordinated, comprehensive global One Health response is essential. The purpose of the present review is to analyze prevailing pathways of transmission between animal reservoirs and human populations. This examination involves the analysis of historical cases, including those of SARS and Ebola, as well as recent occurrences, such as the global pandemic of SARS-CoV-2 (COVID-19). A secondary objective of this review is to comprehend the fundamental mechanisms of cross-species transmission. The development of effective strategies to mitigate the emergence of zoonotic viruses and prevent future pandemics is contingent on a robust understanding of these mechanisms. This analysis is key to identifying pandemic pathogens and preventing the spread of zoonotic viruses. In conclusion, the review provides a thorough evaluation of current global strategies to prevent the spread of zoonotic viruses, highlighting gaps in our understanding and areas for further research. Full article

Seasonal variation in SARS-CoV-2 transmissibility is difficult to estimate directly from year-round epidemic data because interventions, behavior, reporting, immunity, and viral evolution change concurrently. We therefore asked whether cross-country differences observed during the initial exponential-growth phase could be used to infer country-specific seasonal modulation. Early-pandemic basic reproduction numbers (R₀) from 118 countries were linked to 96 harmonized environmental and population-level predictors. Among nine candidate algorithms evaluated across 100 repeated train–test splits, ridge regression using the combined predictor set provided the best balance of predictive accuracy, generalization, and temporal stability. The selected model was then driven by daily climatological covariates to reconstruct annual baseline R₀(t) profiles. Predicted transmissibility generally peaked during winter in the Northern Hemisphere and approximately six months later in the Southern Hemisphere, whereas equatorial countries showed weaker or multimodal patterns. Seasonal forcing amplitude increased strongly with absolute latitude (r = 0.85; mean 0.064 across 77 temperate countries), and predicted R₀ peaks aligned more closely with minimum ultraviolet radiation than with minimum temperature. These ecological associations do not establish causality, but they provide country-specific seasonal-forcing parameters for epidemic models and a baseline environmental context for comparing early-pandemic trajectories. Full article

Coronaviruses are responsible for numerous diseases causing substantial morbidity and mortality to both humans and animals. In particular, they have caused three significant outbreaks in humans including severe acute respiratory syndrome 1 (SARS-CoV-1), Middle East respiratory syndrome (MERS-CoV), and, most recently, the severe acute respiratory syndrome 2 (SARS-CoV-2) pandemic. Two relevant veterinary diseases are porcine transmissible gastroenteritis virus (TGEV) and porcine epidemic diarrhea virus (PEDV), which cause severe losses in the pork industry. While efficacious vaccines were developed in an unprecedented timeframe for COVID-19, vaccines have not been commercialized for other human coronaviruses and vaccines against animal coronaviruses have limited efficacy and logistical challenges in administration. There is a clear need for more efficacious vaccines with simpler methods of delivery and administration for both human and veterinary use. The production of subunit vaccines in plant systems holds great promise in addressing the current challenges and facilitate the preparation for future potential outbreaks and new viruses. This review will summarize the state of development of vaccines in plant systems including tobacco, rice, maize, and others. Full article

Background/Objectives: Atrial fibrillation (AF) and heart failure (HF) frequently coexist, but later-pandemic data from Eastern Europe are limited. We evaluated their documented coexistence in patients hospitalized with COVID-19; the study was not designed to determine whether SARS-CoV-2 modifies the established AF–HF relationship. Methods: We retrospectively analysed 395 adults admitted with RT-PCR-confirmed SARS-CoV-2 infection between 1 September 2022 and 31 December 2024. AF was identified from the admission record, while HF was determined by an audited, rule-based review of cardiovascular free-text entries. A modified Poisson model with robust variance was the primary analysis and estimated adjusted prevalence ratios (aPRs) after adjustment for age, sex, body mass index, hypertension, ischaemic heart disease, pre-existing type 2 diabetes, chronic kidney disease, chronic obstructive pulmonary disease, smoking, and prior ischaemic stroke. Logistic regression and a restrictive NYHA-coded HF definition were sensitivity analyses. Results: AF was documented in 68 patients (17.2%), HF in 106 (26.8%), and both conditions in 26 (6.6%). HF prevalence was 38.2% among patients with AF and 24.5% among those without AF. AF was associated with documented HF in the primary model (aPR 1.51, 95% confidence interval 1.06–2.16; p = 0.022); age was also associated with HF (aPR 1.02 per year, 95% confidence interval 1.01–1.04; p = 0.010). Results were similar with the restrictive HF definition (aPR 1.54, 95% confidence interval 1.07–2.23) and logistic regression (adjusted odds ratio 1.89, 95% confidence interval 1.06–3.37). Exploratory mortality estimates were imprecise and were not used for prognostic inference. Conclusions: AF identified a subgroup with a higher prevalence of documented HF within this hospitalized COVID-19 cohort. The findings are best interpreted as evidence of cardiovascular and multimorbidity complexity, not as proof of a COVID-specific, temporal, or causal AF–HF effect. Full article

Highly pathogenic RNA viruses, such as Ebola, SARS-CoV-2, and influenza, cause severe disease in humans. High mutation rates, which enable RNA viruses to evade immunity and escape antivirals, and their ability to spread from animals to humans and cause pandemics and outbreaks, make RNA viruses significant threats to public health. Diseases caused by Ebola, SARS-CoV-2, and influenza are prevented and treated with only a limited number of approved antiviral drugs, the effectiveness of which is limited by mutations in the viral targets. It is crucial to understand the structural determinants, molecular mechanisms, and host interactions of pathogenic RNA viruses to develop effective antiviral strategies. In this review, we discuss selected RNA viruses, focusing on the structure of their RNA polymerases and interactions with host factors during the different stages of the viral lifecycle, as well as the traditional antivirals targeting these structures and pathways. Furthermore, emerging concepts such as liquid–liquid phase separation and biomolecular condensates, and novel promising antiviral strategies are discussed. Understanding shared and distinct structures, molecular mechanisms, and host interactions across highly pathogenic RNA viruses enables the discovery of new and more effective antiviral strategies, ultimately improving clinical outcomes against evolving RNA viruses. Full article

The approval of safe and effective lipid nanoparticles-encapsulated mRNA (LNP-mRNA) vaccines during the SARS-CoV-2 pandemic is catalysing the development of the next generation of mRNA therapeutics. Accurate characterisation methods are crucial for assessing the quality and efficacy of these complex formulations. Several analytical techniques exist for the quantification of the mRNA drug substance, including UV spectroscopy, capillary electrophoresis, high-performance liquid chromatography (HPLC), and digital PCR (dPCR). Here, we compare these methods, highlight their limitations, and discuss critical considerations for experimental design to improve the agreement between different analytical methods. Full article

Background and Objectives: The pandemic caused by the SARS-CoV-2 infection has been named coronavirus disease 2019 (COVID-19) by the World Health Organization (WHO). Cancer patients may have been more adversely affected during the COVID-19 Pandemic due to their receipt of immunosuppressive treatments, higher burden of comorbidities, and greater nutritional vulnerability compared to the general population. The aim of our study is to identify potential measures by detecting changes in the nutritional statuses of patients with an oncological diagnosis who presented to our hospital during the COVID-19 pandemic, using the globally accepted NRS-2002 questionnaire. Materials and Method: Our study included 324 patients diagnosed with malignancy who applied to the outpatient clinic of Gaziantep University, Şahinbey Training and Research Hospital, Gaziantep/Türkiye, between December 2021 and January 2022 or were hospitalized in the service. Patients included in the study were evaluated in terms of clinical–demographic information and COVID-19-related characteristics using a sociodemographic data form we developed, and then the NRS-2002 questionnaire was administered. Results: Our study included 324 patients. Overall, 49.07% (159 patients) of the patients were male, and 50.93% (165 patients) were female. A total of 20.37% of our patients (66 patients) had COVID-19 disease. While those living with their families constituted 96.91% of the patients, at least one of the family members of 36.42% of the patients had COVID-19 disease. While 76.23% (247 patients) of the patients were vaccinated, 23.77% (77 patients) were not vaccinated. When NRS analyses were examined according to the type of malignancy, a statistically significant difference was found between NRS analyses according to the type of diagnosis. When NRS analyses were examined according to the stages of the diseases, it was determined that stage 4 patients were in the risk group in terms of nutrition. When NRS analyses according to age were examined, it was determined that patients over the age of 65 were in the risk group in terms of nutrition. When NRS analyses by gender were examined, it was found that male patients were in the risk group in terms of nutrition. When the NRS analyses were examined according to whether or not radiotherapy was administered, it was determined that the patients who received radiotherapy were in the risk group in terms of nutrition. Contrary to the literature, no statistically significant difference was found according to whether or not chemotherapy was administered. Conclusions: According to NRS analysis, no statistically significant differences were found in terms of nutritional status according to COVID-19 transmission and vaccination status. When NRS analyses were examined according to the delay of treatment during the pandemic period, it was found that patients who postponed treatment were in the risk group in terms of nutrition, while patients who did not postpone treatment were mostly in the follow-up group. In multivariable analyses, however, no independent relationship was identified between this parameter and NRS-2002 risk. Full article

The SARS-CoV-2 pandemic has significantly impacted global health, politics, medicine, finance, and society. Since 2020, various mutations have been reported, leading to drug resistance in current treatments against different SARS-CoV-2 strains and a drastic increase in cases of long-COVID. This situation underscores the urgent need to develop targeted and effective drugs to combat the spread of SARS-CoV-2 strains and their mutants, manage long-COVID symptoms and prepare for future pandemics. Currently, the treatment of SARS-CoV-2 focuses on targeting the virus’s entry and replication mechanisms to disrupt its life cycle. This review examines approved drugs, clinical candidates, and inhibitors under development, along with their bioassay data, while highlighting associated challenges. It illustrates how inhibitors bind to active sites, providing insights and emphasizing the importance of in silico studies, such as molecular docking, molecular dynamics simulation, FEP+, WaterMap, and quantitative structure–activity relationship (QSAR) analyses, and their correlation with experimental studies in expediting the drug discovery process. The review aims to provide researchers with insights into the gaps that need to be addressed concerning mutations affecting viral entry and to prepare for future pandemics. Full article

Background/Objectives: Seasonal influenza vaccination (SIV) coverage remains suboptimal among adults aged ≥50 years, and the COVID-19 pandemic might influence the determinants of SIV uptake. This systematic review aimed to identify determinants of SIV uptake among adults aged ≥50 years during and after the COVID-19 pandemic. Methods: We searched PubMed, MEDLINE, Embase, Web of Science, Global Health, CINAHL, Cochrane Library, APA PsycINFO, and APA PsycArticles for studies published between 1 December 2019 and 1 January 2026. The pooled prevalence of SIV uptake was synthesized using random-effects models in meta-analysis. Results: A total of 50 studies were included in the systematic review. COVID-19-related factors, such as perceived risk of co-infection with SARS-CoV-2 and seasonal influenza and concerns about potential interactions between COVID-19 vaccines and SIV, were determinants of SIV uptake. Other modifiable determinants included those that existed before the pandemic (e.g., knowledge and perceptions of seasonal influenza and SIV). Subgroup analysis showed that cost and inaccessibility were barriers to receiving SIV in places without a fully subsidized SIV, and perceived susceptibility and vaccine safety concerns were commonly identified as facilitators and barriers in studies with data collected after the pandemic. The pooled prevalence of SIV uptake among adults aged 50 years or above was 53% (95% confidence interval: 44–62%). Such uptake appeared lower among adults aged 50–64 years, in regions without a fully subsidized SIV, and after the COVID-19 pandemic. Conclusions: These findings could inform service planning and interventions promoting SIV uptake among adults aged ≥50 years in the post-pandemic era. More studies are needed to explore determinants specific to people aged 50–64 years to inform health promotion tailored to their needs. 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

Background and Clinical Significance: The COVID-19 pandemic led to the rapid development of effective vaccination strategies. Although COVID-19 vaccines are generally safe, rare hematological adverse events have been reported, most prominently vaccine-induced immune thrombotic thrombocytopenia (VITT). Isolated cases of autoimmune cytopenias and bone marrow failure syndromes following COVID-19 vaccination have also been described. Case Presentation: We report the case of an 80-year-old male who developed subacute-onset severe normocytic anemia with reticulocytopenia and mild leukopenia following heterologous COVID-19 vaccination with ChAdOx1 nCoV-19 (AstraZeneca) and BNT162b2 (Pfizer–BioNTech). Seven days after the second vaccination, mild anemia was detected, progressing over the following weeks to symptomatic anemia requiring hospitalization. Extensive diagnostic evaluation revealed no evidence of hemolysis, nutritional deficiency, autoimmune disease, or viral infection, including SARS-CoV-2 and Parvovirus B19. Bone marrow examination demonstrated an erythroid maturation arrest at the proerythroblast stage, resembling a pure red cell aplasia (PRCA)-like pattern. Cytogenetic and molecular analyses excluded myelodysplastic syndromes. Treatment with erythropoietin resulted in complete hematologic recovery. Conclusions: This case suggests that, in rare instances, COVID-19 vaccination may be temporally associated with transient suppression of erythropoiesis. Further studies are required to elucidate underlying mechanisms and to guide diagnosis and management. Full article

COVID-19, caused by the SARS-CoV-2 coronavirus, emerged as a global pandemic in 2020, with profound impacts on public health and a substantial burden on intensive care units (ICUs). Because critically ill patients are at increased risk of rapid clinical deterioration and death, there is a need for reliable early prognostic biomarkers to support risk stratification and optimize clinical management. Therefore, this study investigated whether clinical and laboratory parameters obtained at hospital admission could serve as prognostic biomarkers for endotracheal intubation and mortality in critically ill patients with COVID-19 admitted to ICUs. A retrospective analytical study was conducted using the medical records of 107 critically ill patients with confirmed COVID-19 admitted to ICUs. Patients were classified according to clinical outcome as survivors (n = 22) or non-survivors (n = 85). Clinical characteristics and laboratory biomarkers obtained at hospital admission were analyzed. D-dimer, lactate dehydrogenase (LDH), red cell distribution width (RDW), the AST/ALT ratio, and age were independently associated with mortality. In addition, D-dimer and LDH demonstrated moderate discriminatory performance for predicting the need for endotracheal intubation. These findings suggest that routinely available clinical and laboratory parameters obtained at hospital admission may serve as complementary prognostic biomarkers to support early risk stratification and clinical decision-making in critically ill patients with COVID-19. Nevertheless, prospective multicenter studies are warranted to externally validate these findings and further establish their clinical applicability. Full article

The SARS-CoV-2 virus has infected approximately 778 million people worldwide since the pandemic. Patients who have survived coronavirus disease (COVID-19) may experience long-term symptoms related to cognitive deficits, mood changes, and depressive disorders. The mechanisms underlying the long-term effects of COVID-19 on the brain are being actively investigated. SARS-CoV-2 infection triggers various mechanisms, such as hyperstimulation of the immune response, which may lead to changes in the central nervous system. In this article, we review the evidence linking COVID-19 to neurodegenerative disorders and cognitive impairment. Current research indicates that patients with pre-existing cognitive and neuropsychiatric deficits have a poorer prognosis after SARS-CoV-2 infection, and patients who have survived COVID-19 may be at increased risk of developing dementia and mood disorders. We analyse the available evidence regarding SARS-CoV-2 brain infection, induction of inflammation, coagulopathy, and blood–brain barrier (BBB) dysfunction as possible mechanisms underlying the disorders in the acute phase of COVID-19 disease and contributing to the development of neurodegenerative disorders in long COVID. Viral infection can trigger inflammation of the central nervous system (CNS), leading to damage and contributing to the development of cognitive dysfunction. Full article