Search Results (3,112)

The outbreak of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has emerged as one of the most significant global health crises in recent history. Coronaviruses are a diverse group of RNA viruses classified into alpha, beta, gamma, and delta genera, with SARS-CoV-2 belonging to the beta-coronavirus family. The virus exhibits high transmissibility and causes a wide spectrum of clinical manifestations ranging from mild respiratory symptoms to severe complications such as acute respiratory distress syndrome, multi-organ failure, and death, particularly among elderly and immunocompromised individuals. Structurally, SARS-CoV-2 possesses a large single-stranded RNA genome encoding major structural proteins, including spike (S), envelope (E), membrane (M), and nucleocapsid (N) proteins, which play critical roles in host-cell recognition and viral infection. Understanding the molecular mechanisms of virus–host interactions, especially protein–protein interactions (PPIs), is essential for uncovering viral pathogenesis and identifying potential therapeutic targets. Traditional experimental techniques for PPI detection, such as yeast two-hybrid and affinity purification methods, are often expensive, labor-intensive, and prone to inaccuracies. Consequently, computational approaches based on machine learning (ML) and deep learning (DL) have gained significant attention for efficient and scalable PPI prediction. These methods use diverse biological information, including protein sequences, structural features, genomic data, Gene Ontology annotations, and interaction networks, to model complex biological relationships. This survey reviews computational approaches to PPI prediction, highlighting ML- and DL-based techniques, methodological advances, performance evaluation practices, and limitations that affect benchmark comparability. It also discusses biological databases and data sources commonly used in PPI studies and explicitly considers how models trained in coronavirus-centered settings may generalize to other viral families with different mechanisms of host interaction. Full article

Background/Objectives: Nursing home residents were among the most vulnerable populations during the COVID-19 pandemic, facing strict restrictive measures, limited access to medical services, and significant psychological consequences derived from institutional confinement. Despite the magnitude of these impacts, the perspective of residents themselves remain underrepresented in the qualitative literature, particularly in the Spanish context. The aim of this study was to analyze and describe the perspectives of residents in a nursing home regarding the restrictive measures adopted by the facility and their access to medical services during the COVID-19. Methods: An exploratory qualitative study was conducted with 24 residents of a nursing home in Cáceres, Spain. Data were collected through in-depth interviews and field notes, and analyze using inductive thematic analysis following Braun and Clarke’s framework. Results: Two main themes were identified: Necessary to feel safe, but unpleasant: accepting the restrictive measures (Accepting the measures; and Better safe, even if unpleasant) and Barriers to healthcare: abandonment, fear, and age-based exclusion (Neglect and abandonment by healthcare system; The residence as a “bubble” and fear of hospital transfer; and Not treated because of our age). Conclusions: The findings highlight the complexity of the experiences of older adults in residential care during the COVID-19 pandemic and underscore the urgent need to balance health protection with psychological well-being, dignity, and the rights of older people in future emergency responses. Full article

Background/Objectives: The acute complications of COVID-19 have been well characterized and are frequently associated with increased mortality. Although substantial knowledge regarding long COVID has accumulated since the beginning of the pandemic, important uncertainties remain regarding the long-term clinical, functional, radiological, and metabolic consequences of SARS-CoV-2 infection. Identification of post-COVID-19 complications is therefore essential for appropriate recognition and management. This study aimed to evaluate the long-term complications of COVID-19 at 3 and 9 months after infection. Methods: This prospective study was conducted at Inonu University Turgut Ozal Medical Center. Patients who presented with active post-COVID-19 complaints or for routine follow-up were enrolled. Participants were evaluated at the pulmonology outpatient clinic at 3 and 9 months. At each visit, persistent or new-onset symptoms were assessed, and pulmonary function tests (PFT), the six-minute walk test (6MWT), echocardiography (ECHO), and thoracic computed tomography (CT) were performed as clinically indicated. Patients were stratified into three groups according to the severity of acute illness: outpatient, ward-hospitalized, and ICU-hospitalized. Results: A total of 205 patients (120 male, 85 female) were included. Male patients had significantly higher rates of ward and ICU hospitalization than female patients (p = 0.006). At 9 months, 85.3% of patients had at least one persistent symptom; dyspnea (69.6%), cough (35.6%), and chest pain (32.5%) were the most common. FVC showed a statistically significant increase between months 3 and 9 (p = 0.014), and the 6MWT distance improved significantly (423.56 m vs. 464.10 m; p = 0.008). Ground-glass opacity, present in 90.2% of patients at admission, persisted in 44.3% at 9 months (p < 0.001). Reticular opacities, pleuroparenchymal bands, and mosaic perfusion patterns increased over time. ICU patients had significantly lower ejection fraction values compared with ward and outpatient groups at 9 months (p = 0.046). During follow-up, 13 patients developed pulmonary embolism and 7 developed new-onset diabetes mellitus. Conclusions: Despite the well-characterized acute phase, the long-term sequelae of COVID-19 remain a significant clinical challenge. Identification of late complications is critical for reducing morbidity and understanding the long-term societal and healthcare burden of the pandemic. Multidisciplinary long-term follow-up is warranted, particularly for patients who experienced severe acute illness. Full article

Background: While vaccines are designed to elicit targeted immune responses, in some cases, the immunogenic molecules employed can inherently interact with broader host cellular pathways as a secondary consequence. This phenomenon can be exemplified by COVID-19 vaccines. COVID-19 vaccines, including mRNA platforms, use the SARS-CoV-2 spike protein as an immunogen to induce the production of neutralizing antibodies. The spike protein binds the ACE2 (angiotensin-converting enzyme 2) receptor on human cells, mediating viral entry and infection. ACE2 is widely expressed across multiple tissues and is a key component of the renin–angiotensin–aldosterone system (RAAS) that acts as a homeostatic regulator of systemic and local blood flow, blood pressure, cardiac function, fluid balance and immunity. Some studies have proposed the interaction between the spike protein and ACE2 as a possible contributing factor to rare adverse effects observed following COVID-19 vaccination, including myocarditis, pericarditis, thrombosis, and reported alterations in blood pressure, though these mechanisms remain to be fully elucidated. Objectives: As a proof-of-concept approach in vaccine antigen development, we engineered SARS-CoV-2 spike mutants with impaired binding to the host receptor ACE2. Methods: By rational design, we produced and validated in vitro and in vivo spike point mutants that do not effectively bind ACE2. Results: The engineered spike mutants do not effectively bind the human entry receptor ACE2 while retaining the immunogenic properties equal to or better than the wild type spike and thus generate a protective response in animals when used as a vaccination agent. Conclusions: By establishing a straightforward molecular strategy for rational vaccine design, this work demonstrates the feasibility of limiting specific antigen–host receptor interactions while maintaining immunogenicity. This approach may be applicable to future vaccination strategies where antigen interaction with host cells could potentially interfere with physiological pathways. Full article

The long-term psychological consequences of COVID-19 remain insufficiently understood in student populations. This study examined the association between post-COVID-19 consequences and psychological functioning in university students, focusing on the mediating role of trait anxiety. A total of 7482 students aged 17 to 23 years completed an online survey assessing COVID-19 history, post-COVID-19 consequences, psychological well-being (WHO-5), subjective happiness (SHS), life satisfaction (SWLS), and trait anxiety (STAI). Participants were classified into three groups: no history of COVID-19, COVID-19 without post-COVID-19 consequences, and COVID-19 with post-COVID-19 consequences. Group differences were analyzed using ANOVA with Tukey post hoc tests, followed by regression and mediation analyses controlling for age and sex. Students reporting post-COVID-19 consequences showed higher trait anxiety and lower psychological well-being, subjective happiness, and life satisfaction than both comparison groups. Regression analyses indicated that poorer psychological functioning was associated specifically with post-COVID-19 consequences rather than COVID-19 history per se. Mediation analyses among previously infected students showed that trait anxiety statistically mediated these associations, accounting for 61% of the effect on psychological well-being, 84% on subjective happiness, and 68% on life satisfaction. These findings highlight trait anxiety as an important psychological factor statistically accounting for the association between post-COVID-19 consequences and reduced well-being. Full article

The world has already been facing food, nutrition, and security challenges for the last few decades. The coronavirus 2019, COVID-19, has a significant impact on food security and agriculture, such as affecting food demand and the food supply chain, with the greatest consequences on the most vulnerable population. This review provides a comprehensive overview of the effects of COVID-19 on global agriculture and food security, drawing on recent scientific publications, institutional reports, and policy documents from 2020 to 2026. The review examines the impact of the pandemic on cropping patterns, fruit and vegetable harvests, availability of farm inputs, connectivity of the agricultural system, food supply chains, food demand, and labor availability. Vegetable and fruit markets were most affected due to the spread of COVID-19. Due to the closing of markets and restaurants, produce distributors and farmers were required to transfer supplies entirely from the food production to the marketplace. These effects are additionally being felt in agriculture and food security. Almost 55% of researchers indicated that COVID-19 has the most impact on agriculture and its complete harvest during the season, and an additional 45% stated that COVID-19 has adversely affected food security. However, food has slowed down well to date in numerous nations. The spread of COVID-19 is beginning to disrupt the supply of agricultural products and food to consumers and the marketplace across and within borders. The different spring crops, such as sunflower, canola, maize, barley, spring wheat, and various field vegetables, cannot be grown during COVID-19. Consequently, COVID-19 has had a binding effect on the food supply chain and agriculture due to the disruption, which the government should have addressed promptly. Full article

Background: Monoclonal antibodies (mAbs) initially played a major role in outpatient COVID-19 management by providing rapid passive immunity and reducing progression to severe disease. However, continuous SARS-CoV-2 evolution progressively compromised the effectiveness of several anti-spike products. This narrative review summarizes the trajectory of COVID-19 mAbs across three phases: early clinical efficacy, loss of efficacy due to immune escape, and future directions. Methods: We conducted a narrative review focusing on mechanisms of action, pivotal clinical trials, and real-world effectiveness of neutralizing anti-spike mAbs and host-directed immunomodulatory mAbs. Emphasis was placed on the impact of variants—especially Omicron—on susceptibility and clinical use, as well as on emerging next-generation platforms. Results: First-generation neutralizing mAbs substantially reduced the hospitalization rates during the Alpha and Delta waves, while immunomodulatory mAbs became standard options for the hyperinflammatory phase in hospitalized patients. With the emergence of Omicron and its sub-lineages, extensive immune escape led to marked reductions in neutralization for many earlier anti-spike agents and consequent restrictions in use. Later-generation approaches targeting more conserved epitopes provided temporary solutions but were also challenged by ongoing antigenic drift. Host-directed immunomodulators retained clinical relevance because their mechanism is independent of viral spike mutations. Conclusions: The clinical role of monoclonal antibodies in COVID-19 has been dynamic and increasingly constrained by viral evolution. Future strategies should prioritize broadly neutralizing antibodies targeting conserved epitopes, innovative delivery platforms, and integration with real-time surveillance to preserve clinical utility in the endemic phase and improve preparedness for future outbreaks. Full article

Urban air quality management has been playing a significant role due to its effects on public health and pollution characteristics of countries with constantly changing policies. Traditional approaches capture how much pollution is present but are unable to detect changes in the chemical character of the atmosphere, the relationships between co-emitted species, the balance of photochemical processing, and the combustion fingerprint of emission sources. This study introduces a framework that identifies and diagnoses such evolutions within the pollutants of the atmosphere. A chemistry-aware Variational Autoencoder is trained on 19 multivariate pollution features (7 raw concentrations, 5 chemical ratios, 7 temporal gradients) at London Marylebone Road (urban roadside) and North Kensington (urban background) from 2015 to 2019, and tested on 2022–2025. A four-method ensemble framework (VAE reconstruction error, reconstruction probability, Isolation Forest, and statistical Z-score) requires ≥3 agreement to identify high-confidence departed pollution states. Per-feature decomposition of the reconstruction probability diagnoses the chemical character of each departure. At the roadside site, 14.5% of post-COVID hours fall within departed states, dominated by the CO/NO_x combustion ratio (513.2) and the photostationary state proxy (391.4), chemical relationships rather than individual concentrations. This indicates that at the point of emission, London’s fleet modernisation and Ultra Low Emission Zone (ULEZ) have changed the combustion fingerprint and photochemical equilibrium. The same structural indicators are carried over during the COVID-19 lockdown; however, O₃ rises 3.2× during the pandemic period, reflecting suppressed NO titration. Conversely, at the urban background site, where the departures are driven by concentrations and boundary-layer trapping ($r=-0.659$), the combustion fingerprint of the atmosphere is invisible to detect (CO/NO_x$=-45.0$). These findings indicate that London’s emission landscape has undergone fundamental transformations over the past decade, and the consequences of ULEZ and similar interventions or greater impacts of pandemic-related events are non-homogeneously distributed across the relevant region. Full article

Background and Objectives: The COVID-19 pandemic was associated with major disruptions, not only at the environmental, social, and economic levels but also in the public health systems and, therefore, emergency care utilisation. Prior to the pandemic, one of the most significant issues in the ED was overcrowding, with a consequent percentage of people leaving the ED without being seen (LWBS). The aim of this study was to assess the association between the 2020 COVID-19 pandemic and the number of LWBS, compared with the rates recorded during the same period in 2019 and 2021. Materials and Methods: A retrospective comparative observational study of ED admissions was conducted in two university hospitals in Ancona (Italy) between 9 March and 3 May 2020 and in Gran Canaria (Spain) between 14 March and 10 May 2020, corresponding to the lockdown in the two countries, respectively. ED visits were assessed during the defined periods, separately for the Italian and Spanish contexts and between groups, comparing the two contexts for each year. Results: In Italy, during the 2019 timeframe, 597 (7.0%) of 8568 patients who arrived in the ED left before being seen; during the same period in 2020, 100 (3.2%) of 3100; and in 2021, 334 (6.0%) of 5555. In Spain, patients leaving the ED prior to medical consult in 2019 were 567 (4.0%) out of 14,034 visits; in 2020, they amounted to 185 (2.6%) out of 7208; and in 2021, they were 528 (4.0%) out of 13,214. The results of the logistic regression analysis for Italy and Spain showed that male sex [odds ratio (OR), 95% confidence interval (CI): 1.38 (1.24–1.53)], age group between 17 and 43 years compared to those subjects older than 74 years old [OR (95%CI): 4.04 (3.34–4.88)] and a lower priority code at triage were significantly associated with a higher odds of LWBS. Conclusions: The findings suggest that the COVID-19 pandemic was associated with changes in only some characteristics of the profiles and types of patients leaving the ED, while it had a strong impact on the number of patients who left the ED before medical examination. The observed decrease in ED visits and LWBS rates in 2020 suggests that the COVID-19 pandemic has changed the population’s use of the ED, highlighting the potential need for improved public and professional awareness of appropriate care pathways and the role of health professionals in them. Full article

Introduction: The global spread of the SARS-CoV-2 pandemic led to a serious health, social and economic global crisis. This pandemic was and remains the most important health emergency worldwide, for which all professionals have been called to provide diagnosis and treatment support. Despite early concerns about safety, forensic medicine has contributed to a better understanding of the pathological mechanisms involved. Objective: This study aims to describe and analyze the postmortem pathological findings in confirmed SARS-CoV-2 cases, emphasizing the contribution of forensic autopsies to elucidating the mechanisms of death and associated comorbidities. Methods: A retrospective study was conducted on 279 autopsies between 2020 and 2022. Demographic, clinical, and pathological data were collected and statistically analyzed. Results: Following the descriptive analysis of the cases included in the study, as well as the analysis of the relevant scientific literature, the major impact of the COVID-19 pandemic was highlighted in terms of the death mechanisms involved, occurring consequences and induced changes. Conclusions: Autopsies remain the essential tools for investigating COVID-19-related deaths. The findings confirm that SARS-CoV-2 primarily affects the pulmonary and cardiovascular systems. However, the overlap between “death from” and “death with” COVID-19 highlights the need for standardized postmortem diagnostic criteria and comprehensive clinical–pathological correlation. Full article

This paper investigates multiple shocks from climate policy uncertainty (CPU) and green finance (GF) to carbon prices (CAPs) using the joint impulse response function (jIRF) method. The empirical findings indicate that jIRF estimates of CPU and GF on CAPs are more accurate compared to the simple sum of generalized impulse response functions, primarily due to the consideration of cross-correlations among simultaneous shocks. This highlights GF’s potential to alleviate the effects of CPU over the entire study period. Moreover, this study focuses on the post-pandemic era and reveals a positive association between GF and CAPs, indicating the evolving role of ecological governance. A key contribution lies in the introduction of the jIRF, which captures the interdependencies among concurrent shocks and underscores the evolving role of GF both before and after the COVID-19 pandemic. This study enhances the theoretical foundation of GF by illustrating its adaptation to changing macroeconomic conditions. Consequently, this study underscores the imperative for China to sustain economic growth, ensure consistency in climate policies, and bolster market-oriented reforms in green financing and carbon markets. Full article

Background and Objectives: The COVID-19 pandemic caused unprecedented mortality shocks worldwide, but its differential impact across European regions and the mediating mechanisms remain inadequately quantified. Materials and Methods: We conducted a longitudinal multilevel analysis using data from 29 European countries (2015–2023; N = 261 country-years). Linear mixed models estimated the impact of the pandemic on life expectancy, controlling for regional differences, vaccination rates, healthcare expenditures, gross domestic product, and excess mortality. The primary outcome was national life expectancy at birth. Results: The pandemic period was associated with an average reduction of 1.12 years in life expectancy (95% CI: 0.95 to 1.49, p < 0.001) after adjusting for pre-existing trends. Eastern Europe experienced 56% greater impact than Western Europe (interaction β = −0.623, p = 0.002). Excess mortality emerged as the primary mediator, explaining 79% of the pandemic effect. Each 1% increase in excess mortality reduced life expectancy by 0.091 years (p < 0.001). Healthcare expenditures showed protective effects (β = 0.000327 per purchasing power standards (PPS), p = 0.049), while vaccination rates, as a direct predictor, were not significantly associated with life expectancy in multivariate models. This critical finding on vaccination rates does not imply biological inefficacy but rather suggests a misspecification of its role. Conclusions: Excess mortality, rather than its direct component, COVID-19-specific mortality, appears to mediate most of the pandemic’s impact on life expectancy. Regional disparities reflect structural differences in healthcare systems and socioeconomic conditions more than differential vaccination uptake. The protective effect of vaccination on life expectancy operates entirely through the reduction in excess mortality. Consequently, health policies should prioritize strengthening resilient health systems as well as disease-specific interventions. Full article

Background: The COVID-19 pandemic has been a global crisis, affecting healthcare systems and professionals worldwide. This study investigates the prevalence and factors associated with burnout and insomnia among Greek physicians affiliated with the Athens Medical Association after the acute phase of the COVID-19 pandemic. Methods: Data were collected through an anonymous online survey distributed to active physician members of the Athens Medical Association between 15 June 2023 and 15 July 2023. Burnout was assessed using the Maslach Burnout Inventory (MBI), and insomnia was assessed using the Athens Insomnia Scale (AIS). Descriptive, unadjusted, and multivariable analyses were performed. Results: A total of 1023 physicians participated. Insomnia (AIS ≥ 6) affected 83.0% of the participants. Based on standard MBI cut-offs, 52.4% had high emotional exhaustion, 35.9% had high depersonalization, and 39.2% had low personal accomplishment. In multivariable logistic regression, older age was significantly associated with lower odds of insomnia, while public-sector employment and high concern about future career consequences were associated with higher odds. In multiple linear regression models, a higher AIS total score was significantly associated with higher emotional exhaustion and depersonalization and with lower personal accomplishment. Conclusions: These findings suggest high rates of insomnia and burnout in this physician sample. Greater insomnia was significantly associated with less favorable scores across all three burnout dimensions. Younger age, public-sector employment, and higher concern about future career consequences were associated with insomnia. These findings should be interpreted as associations, rather than causal effects. Full article

Background: The COVID-19 pandemic caused disruptions in HPV vaccination and may have severely undermined global cervical cancer prevention, posing long-term risks to controlling cervical cancer and other HPV-related diseases. Objective: We conducted a scoping review to map and synthesize available evidence on how the COVID-19 pandemic has affected human papillomavirus (HPV) vaccination programs in low- and middle-income countries (LMICs) focusing on changes in vaccine delivery and coverage, determinants of uptake, economic and programmatic consequences and vaccine hesitancy. Methods: Inclusion criteria were limited to studies published in the English language between January 2020 to May 2025, and followed JBI and Arksey & O’Malley’s scoping review guidelines. The review proceeded through three stages: database searches, gray literature and citation tracking and used a PRISMA-ScR checklist to guide narrative and tabular synthesis. Results: A total of 1063 records, 57 studies were included in the final analysis, and these were spread out across 37 low- and middle-income countries (LMICs) mainly in Africa, Asia, and Latin America. Our analysis revealed that HPV vaccination coverage declined substantially during the COVID-19 pandemic, with reductions of up to 90% reported across the included studies, in the context of school closures, workforce redeployment, and supply-chain disruptions. Recovery efforts also faced major barriers including vaccine hesitancy, misinformation about COVID-19 vaccines, and travel restrictions. Strategies like digital tools, mobile clinics, and community health workers showed promise alongside integrated school- and facility-based approaches, although there is limited evidence on cost-effectiveness and long-term sustainability of these strategies. Conclusions: HPV vaccination in LMICs was significantly disrupted by the COVID-19 pandemic due to unreliable vaccine supply chains, health-worker shortages, and challenges tied to school-based vaccine delivery. Although recovery methods show potential, longer observation periods are needed to determine their full effectiveness. Full article

Background and Objectives: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy has raised concerns regarding possible fetal consequences, including potential effects on auditory system development. Although the current literature suggests that overt congenital hearing loss is uncommon among newborns exposed in utero, subtle cochlear functional alterations may not be detectable through conventional threshold-based screening alone. The objective of this study is to investigate whether in utero exposure to maternal COVID-19 is associated with early cochlear functional changes in newborns, as assessed by frequency-specific transient evoked otoacoustic emission (TEOAE) amplitude ratios, and to determine whether such alterations are accompanied by differences in click-evoked auditory brainstem response (ABR) thresholds. Materials and Methods: This prospective cohort study was conducted between October 2021 and September 2022 and included 61 pregnant women: 30 with laboratory-confirmed SARS-CoV-2 infection during pregnancy (study group) and 31 without documented infection (control group). All newborns underwent standardized audiological evaluation shortly after birth, including otoscopy, TEOAE, click-evoked ABR, and tympanometry. Frequency-specific TEOAE amplitude ratios at 500, 1000, 1500, 2000, and 4000 Hz were compared between groups. A logistic regression analysis was performed to identify audiological predictors of newborn exposure to SARS-CoV-2 in utero. Results: No significant differences were observed in ABR thresholds or in TEOAE “pass/refer” outcomes between the control and study groups, indicating the absence of clinically overt HL. However, newborns exposed to SARS-CoV-2 in utero showed significantly reduced TEOAE amplitude ratios at 2000 Hz (p = 0.0077) and 4000 Hz (p = 0.020). Logistic regression identified the 4000 Hz amplitude ratio as an independent negative predictor of in utero exposure (OR = 0.75; p = 0.0352). No significant differences were detected at lower frequencies. Conclusions: Maternal COVID-19 during pregnancy was not associated with immediate neonatal HL but was linked to subtle high-frequency cochlear functional modulation. Longitudinal audiological follow-up is needed to clarify the clinical significance of these findings. Full article