Search Results (341)

Mental health disorders, particularly depression and anxiety, have become increasingly prevalent among elite athletes, exacerbated by factors such as competitive pressure and the Coronavirus Disease 19 (COVID-19) pandemic. This study analyzes trends in the use of antidepressants, anxiolytics, and cannabinoids (delta-9-tetrahydrocannabinol (THC)/cannabidiol (CBD)) among Italian athletes from 2011 to the first half of 2023 (FH2023), referring to anti-doping reports published by the Italian Ministry of Health. Data from 13,079 athletes were examined, with a focus on non-prohibited medications, banned substances, and regulatory impacts, including threshold adjustments for THC since 2013 and the legalization of CBD. The results show fluctuating use of antidepressants/anxiolytics, with peaks in 2021 and the FH2023, coinciding with post-pandemic awareness. Positive THC cases rose following regulatory changes, reflecting socio-cultural trends. Gender disparities emerged, with THC use predominantly among males (e.g., nine males vs. one female in 2013), though female athletes were underrepresented in testing. This study highlights the need for personalized, evidence-based strategies that balance therapeutic efficacy and anti-doping compliance. Clinicians should carefully consider prescribing selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines to address depression and anxiety and should monitor the risks of CBD contamination. Future research should adopt longitudinal, gender-sensitive approaches to refining guidelines and combating stigma in professional sports. Full article

Background: The COVID-19 (coronavirus disease 19) pandemic has underscored the urgent need for effective antiviral agents targeting viral entry mechanisms. This study investigated the inhibitory effects of heparan sulfate (HS) and enoxaparin (EX) on the interaction between the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein and the angiotensin-converting enzyme 2 (ACE2) receptor. Methods: A pseudovirus model was employed to evaluate the efficacy of HS and EX under different treatment strategies: pre-treatment of host cells, pre-treatment of the viral particles, and simultaneous co-treatment. Results: Both compounds significantly inhibited viral entry. EX exhibited a dose-dependent effect under all treatment conditions. In cell pre-treatment, EX achieved the highest levels of inhibition, whereas HS demonstrated consistent inhibitory activity that was largely concentration-independent. Viral pre-treatment revealed that both compounds effectively reduced infectivity by interfering directly with viral particles. In the co-treatment experiments, HS demonstrated superior inhibitory activity at lower concentrations compared to EX. Conclusions: The results suggested that HS and EX inhibit SARS-CoV-2 entry via distinct mechanisms. HS likely acts via competitive inhibition at the host cell surface, while EX may bind directly to the spike protein, thereby preventing engagement with the ACE2 receptor. These findings highlight the therapeutic potential of HS and EX as entry inhibitors targeting the early stages of SARS-CoV-2 infection. Further studies are warranted to evaluate their efficacy against emerging variants and in vivo models. Full article

Background and Objectives: Coronavirus disease 2019 (COVID-19) triggers a dysregulated host response that may culminate in refractory hypoxaemic shock. Whether veno-venous ECMO modifies the inflammatory cascade more effectively in COVID-19 than in other septic states, and how it compares with conventional ventilatory support for COVID-19, remains uncertain. We compared three groups: COVID-19 patients supported with ECMO (COVID-ECMO, n = 25), non-COVID-19 septic shock patients on ECMO (SEPSIS-ECMO, n = 19) and critically ill COVID-19 patients managed without ECMO (COVID-CONV, n = 74). Methods: This retrospective study (January 2018–January 2025) extracted demographic, laboratory and clinical data at baseline, 48 h and 72 h. The primary end-point was the 72 h change in SOFA score (ΔSOFA). The secondary end-points included the evolution of interleukin-6 (IL-6), C-reactive protein (CRP), D-dimer and ferritin; haemodynamic variables; and 28 day mortality. A post hoc inverse-probability-of-treatment weighting (IPTW) sensitivity analysis adjusted for between-group severity imbalances. Results: Baseline APACHE II differed significantly (29.5 ± 5.8 COVID-ECMO, 27.4 ± 6.1 SEPSIS-ECMO, 18.2 ± 4.9 COVID-CONV; p < 0.001). At 48 h, IL-6 fell by 51.8% in COVID-ECMO (−1 116 ± 473 pg mL⁻¹) versus 32.4% in SEPSIS-ECMO and 18.7% in COVID-CONV (p < 0.001). The ΔSOFA values at 72 h were −4.6 ± 2.2, −3.1 ± 2.5 and −1.4 ± 1.9, respectively (p < 0.001). ECMO groups achieved larger mean arterial pressure rises (+16.8 and +14.2 mmHg) and greater norepinephrine reduction than COVID-CONV. The twenty-eight-day mortality was 36.0% (COVID-ECMO), 42.1% (SEPSIS-ECMO) and 39.2% (COVID-CONV) (p = 0.88). Across all patients, IL-6 clearance correlated with ΔSOFA (ρ = 0.48, p < 0.001) and with vasopressor-free days (ρ = 0.37, p = 0.002). Conclusions: ECMO, regardless of aetiology, accelerates inflammatory-marker decline and organ failure recovery compared with conventional COVID-19 management, but survival advantage remains elusive. COVID-19 appears to display a steeper cytokine-response curve to ECMO than bacterial sepsis, suggesting phenotype-specific benefits that merit confirmation in prospective trials. Full article

Background/Objectives: This retrospective observational study investigated coronavirus disease 2019 (COVID-19)-related mortality trends in the US throughout the pandemic. Methods: We performed a retrospective, descriptive analysis between 2020 and 2024 using data from the US National Center for Health Statistics. Results: The total number of COVID-19 deaths rose by 19% from 2020 to 2021, followed by a significant decline in the subsequent years, with an average reduction factor of 0.44. Mortality rates remained higher in males compared to females, with a gender disparity between 52 and 62%. Age-specific crude mortality rates increased with advancing age, with higher mortality observed in older populations. However, crude death rates significantly declined across all ages except for the 1–4 years group, which experienced a 33% increase. The majority of fatalities occurred in medical facilities (63–80%), but this proportion gradually decreased over time, while the percentage of deaths occurring at home nearly doubled from 2020 to 2024 (6% to 11%). Conclusions: The initial mortality peak for COVID-19 was followed by a substantial decline, likely influenced by the widespread availability of vaccines, improvements in clinical management, and the emergence of less virulent variants. The persistent gender and age disparities, alongside the fluctuating distribution of the places of death, offer insights for refining healthcare policies and optimizing resource allocation in this and other future pandemics. Full article

After the transition of coronavirus disease 2019 (COVID-19) from a pandemic to an endemic phase, data on respiratory viral infections remain limited. This study compared the clinical outcomes of SARS-CoV-2, influenza virus (INFV), and respiratory syncytial virus (RSV) infections and investigated how underlying medical conditions influence disease severity. During Omicron subvariant dominant periods, we conducted a multicenter, retrospective cohort study including laboratory-confirmed cases of SARS-CoV-2, INFV, and RSV infections in hospitalized patients aged ≥ 19 years. We compared demographic characteristics and clinical outcomes and analyzed the association between underlying comorbidities and severity of infection. A total of 1850 cases with SARS-CoV-2, 98 with INFV, and 63 with RSV infections were analyzed. Notable differences in the occurrence of fever, cough, sputum, and dyspnea were observed among patients with the three different viral infections. Pneumonia was diagnosed more frequently in patients with RSV infection (65.6%) compared to those with INFV infection (42.9%) and SARS-CoV-2 (34.4%) (p < 0.01). For patients with SARS-CoV-2 infection, the risk of pneumonia increased by 47% in the moderate-risk group and 37% in the high-risk group. Among hospitalized patients, pneumonia was more frequently identified in patients with RSV infection, with statistical significance. Furthermore, the presence of medical conditions significantly increased the risk of developing pneumonia. Full article

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused the coronavirus disease 19 (COVID-19) pandemic, significantly impacting global health, economies, and social stability. In February 2020, the first cases of SARS-CoV-2 infections in animals were documented, highlighting the potential risks posed by regular human–animal interactions in facilitating viral transmission. In consequence, it is essential to validate surveillance methods for SARS-CoV-2 in animals. In the present study, 101 sera from different animal species (36 cats, 41 dogs, 4 ferrets, 10 wild boar, 6 domestic goats, and 4 lions) were tested using three different ELISA kits to evaluate humoral responses against SARS-CoV-2. ELISA results were compared and correlated with a pseudovirus neutralization test (pVNT), considered as the reference assay. ELISA-1, targeting the receptor binding domain (RBD) neutralizing antibodies (nAbs) of SARS-CoV-2, exhibited the highest diagnostic performance, and proved to be a reliable tool for initial screenings in high-throughput animal studies. In contrast, ELISA-2 (also targeting RBD nAbs) and ELISA-3 (targeting nucleoprotein antibodies) demonstrated lower sensitivity for detecting seropositive animals. Full article

Background and Objectives: Therapeutic interventions, such as extracorporeal membrane oxygenation (ECMO) therapy, in patients suffering from severe acute respiratory distress syndrome (ARDS) may reduce their vitamin D levels. Many observational studies have shown associations between poor outcomes and low vitamin D levels in critically ill patients. This retrospective study primarily aimed to investigate the time-dependent changes in vitamin D levels and the correlation of vitamin D levels with disease severity and inflammatory markers in patients suffering from ARDS receiving ECMO therapy. Materials and Methods: This study used a longitudinal approach to assess the serial changes and the correlations of vitamin D levels (25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)2D)) with disease severity and inflammatory markers in 24 invasively mechanically ventilated (IMV) patients treated using ECMO over a period of 17 days. Most of the patients in this study were suffering from severe coronavirus disease 2019 (COVID-19) (n = 19; 79%). Serial blood samples collected during routine blood draws were retrospectively analyzed to assess the dynamics of their vitamin D levels over 17 days of ICU therapy. Results: Hypovitaminosis D (25(OH)D ≤ 50 nmol/L) was prevalent in 18 (75%) patients, while values of 25(OH)D lower than 30 nmol/L were measured in 5 patients (21%), indicating severe deficiency. Additionally, 1,25(OH)2D showed a significant decrease within the first 11 days of intensive care unit (ICU) treatment (these levels dropped by 28%; p = 0.03) and then remained at similar levels throughout the observational period; 25(OH)D levels remained largely unchanged during the observation period. We observed that 25(OH)D showed a significant negative correlation with C-reactive protein (CRP) (p = 0.04), and that 25(OH)D and 1,25(OH)2D levels did not show correlations with disease severity. Conclusions: Patients suffering from severe COVID-19 ARDS showed a significant decrease in their 1,25(OH)2D levels from day 0 to day 11 in the ICU. Therefore, routine vitamin D substitution and monitoring in critically ill patients, especially for patients suffering from ARDS treated with ECMO, should be carried out to prevent hypovitaminosis D. In addition, vitamin D may be associated with inflammation. Further studies are necessary to elucidate the mechanisms behind these retrospective observations. Full article

Background: In 2021, Taiwan’s healthcare workers faced significant stress due to the coronavirus disease 2019 (COVID-19) pandemic. This study aims to enhance healthcare workers’ self-awareness of their stress and improve their work efficiency by using symphonic poetry to inspire resilience. Methods: This qualitative study involved in-depth interviews with a panel of physicians, nurses, and specialist nurses. The interviews were conducted using ATLAS—ti 7.5 qualitative analysis software for content analysis. Participants must have attended the “Meeting Mahler, Meeting Myself” concert organized by the medical center. The concert was based on the poetry from the fifth movement of Mahler’s Symphony No. 2, “Resurrection”, and included symphonic poetry and a manual. The manual combined pictures and a complementary interview guide to facilitate participants sharing their pandemic experiences and health. Results: A total of 19 healthcare workers participated in the interviews. All participants had attended the institute’s symphonic poetry concert “Meeting Mahler, Meeting Myself”. The average age of the participants was 44.1 ± 11.4 years, and their average working experience was 19.1 ± 13.1 years. The group included nine physicians (47.4%), eight nurses (42.1%), and two specialist nurses (10.5%). The results were categorized into three major themes: “Pandemic-Induced Physical and Mental Exhaustion”, “Symphonic Poetry as a Tool for Building Resilience”, and “Enhancing Mental Toughness to Overcome Adversity”. Conclusions: Healthcare workers experienced stress and exhaustion during the pandemic. Symphonic poetry can serve as a supportive tool to inspire resilience and enhance mental toughness among healthcare professionals facing pandemic-related challenges. Full article

Background/Objectives: People with HIV (PWH) often have a suboptimal response to vaccines, raising concerns regarding the efficacy of coronavirus disease 2019 (COVID-19) vaccines in this population. We aimed to evaluate the humoral immune response to the B.1 lineage and Omicron variant in PWH on antiretroviral therapy (ART) following COVID-19 vaccination. Methods: We conducted a prospective study of 19 PWH on ART who received a two-dose series of the COVID-19 mRNA vaccine and a booster six months later. Participants without HIV infection (n = 25) were included as a healthy control (HC) group. The humoral response to the COVID-19 vaccine (anti-SARS-CoV-2 S IgG levels and ability to block ACE2-S interaction) against both the original B.1 lineage and the Omicron variant was assessed using immunoassays. Results: The humoral response in PWH was very strong (geometric mean fold rise, GMFR > 8) after the second dose and strong (GMFR > 4) after the booster dose for both the B.1 lineage and the Omicron variant. We found comparable humoral responses to the B.1 lineage and Omicron variant between PWH and HC groups after the second and booster doses (q-value > 0.05). The COVID-19 vaccine generated a significantly weaker humoral response against the Omicron variant compared to the B.1 lineage in both groups (q-value < 0.05). However, this response improved after the booster dose, although it remained weaker in PWH. Conclusions: PWH showed a strong humoral response to the COVID-19 vaccine against B.1 and Omicron, though the Omicron response was weaker than B.1. Booster doses in PWH improved the Omicron response, but it stayed lower than B.1. Findings confirm vaccine effectiveness in PWH, stressing the critical role of boosters and potential need for updated vaccines for variants like Omicron. Full article

Background: The Coronavirus disease (COVID-19) pandemic profoundly impacted education, causing uncertainty and constant changes for teachers, including new teaching modalities, increased workloads, and limited rest periods. Global studies have reported mental health issues such as anxiety and depression among educators during and after the pandemic, primarily in Asia, Europe, and North America. However, these existing studies often show increased anxiety and depression rather than considering school-based predictors that may contribute to increasing rates. Aims: Despite these global findings, there are few investigations of the impact of COVID-19 on teachers in Latin America and Spain. To address these notable global and regional research gaps, this study examined the prevalence and predictors of depression and anxiety symptoms among teachers in Latin America and Spain. Method: An online survey collected data on demographics, work-related characteristics, COVID-19 experiences, and measures of mental health from teachers in 19 Latin American countries and Spain using a snowball sampling approach. The sample comprised 2004 teachers, with 81.8% female participants and a mean age of 44.46 years (SD = 9.8). Descriptive statistics and hierarchical multiple linear regressions were conducted with depression and anxiety as outcome variables. Results: Consistent predictors of increased anxiety and depression symptomology included being female or transgender, being younger, having lower socioeconomic status, having pre-existing mental health conditions or chronic illness, having increased workload during the pandemic, being dissatisfied with teaching resources, and having negative changes in relationships with students, parents, or colleagues. The predictors collectively explained 16.4% of the variance in depression and 17.5% of the variance in anxiety symptoms. Conclusions: The significant mental health needs of teachers in Latin America and Spain during the COVID-19 pandemic highlight the pressing necessity of prioritizing the mental health needs of educators to improve their psychological health and children’s educational environments. These results also suggest the practical need to provide teachers with additional school-based supports and resources for future transitions to online learning or disruptions to traditional instruction. Full article

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) underwent significant mutations, resulting in the Omicron variant. Methods: In this study, we analyzed blood samples from 98 patients with acute coronavirus disease 19 (COVID-19) hospitalized during the initial SARS-CoV-2 wave and the onset of Omicron in 2021. High-resolution melting (HRM) analysis of PCR products was used to analyze RNA extracted from clinical samples collected in July and November 2021 from patients infected with SARS-CoV-2. Results: HRM analysis revealed a characteristic deletion in the N protein RNA of the virus isolated in November 2021, associated with the Omicron variant. Elevated levels of inflammatory markers and interleukin-6 (IL-6) were observed in both waves of COVID-19. Complement levels and IgG and IgM antibodies to SARS-CoV-2 were detected more often during the second wave. An increase in hemagglutinin-inhibiting (HI) antibodies against influenza viruses was observed in paired blood specimens from moderate to severe COVID-19 patients during both outbreaks. Conclusions: Patients admitted during both waves of COVID-19 showed a significant rise in inflammatory markers, suggesting that Omicron triggers inflammatory responses. The rapid formation of IgM and IgG in Omicron may indicate a faster immune response. Seasonal flu may negatively impact the clinical course of coronavirus infections. Full article

The Coronavirus disease 2019 (COVID-19) pandemic significantly impacted the circulation patterns of respiratory viruses worldwide. To better understand viral circulation patterns during the transition from pandemic to endemic phase, we conducted comprehensive respiratory virus surveillance in Mie Prefecture, Japan, during 2021–2023, coinciding with the Delta-to-Omicron transition of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). We collected respiratory specimens from acute respiratory infection patients in medical institutions, detecting 19 respiratory viruses using real-time PCR in 1573 valid samples out of 1605 specimens. Demographic and clinical data were available for some specimens. SARS-CoV-2 Omicron strains showed a peak positivity of 15–25% during the epidemic, while respiratory syncytial virus and human rhinovirus/enterovirus exhibited one to two annual epidemic peaks up to 57%, and human adenovirus maintained a positivity rate of 5–20% throughout the year. Age-dependent analysis revealed the significant detection of multiple viruses, particularly in children under 2 years, with up to six viruses detected simultaneously in those under 5 years. Our findings demonstrate varied respiratory virus prevalence patterns, with some viruses remaining active during the Omicron epidemic, suggesting its limited impact on other viruses. This comprehensive approach should enhance the understanding of respiratory virus epidemic dynamics and inform public health strategies. Full article

Background: Nationwide studies described a reduction in preterm birth (PTB) during the Coronavirus disease 19 (COVID-19) pandemic, but this was not confirmed in others. Very few data are available on the trend of PTBs over a longer period, including the post-pandemic period, and on potential risk factors, especially those associated with social disparities. Objective: To investigate the trend in PTB rates and the influence of maternal risk factors in Italy from January 2018 to December 2022, based on 12 Regional Birth Registries covering 86.1% of Italian births. Methods: PTB trend was investigated by an interrupted time series analysis. We assessed the associations of potential risk factors with PTB (Poisson regressions) and calculated their population impact fractions (PIFs). Results: We studied 1,762,422 births; 7.25% were PTB. Before the pandemic, we observed a monthly decrease in PTB rate [−0.2% (95% CI: −0.3; −0.1)]; from July 2020 onwards, the average monthly level of PTBs was 5% lower than before (95% CI: −7.3; −2.7), with a flat trend until December 2022 [−0.02% (95% CI: −0.5; 0.5)]. Socio-economic maternal risk factors (low education, unemployment) and foreign nationality, whose risk ratios were 1.14 (95% CI: 1.04; 1.24), 1.08 (1.05; 1.12), and 1.17 (1.14; 1.21), respectively, showed a decreasing trend after pandemic; their impact on the decrease in PTBs was modest (PIFs between −2.4‰ and −4.2‰). Conclusions: The COVID-19 pandemic changed the pattern of PTB rates in Italy, lowering their average frequency and interrupting a previous decreasing trend. Changes in the trend of socio-economic maternal risk factors marginally explained this pattern. Full article

Since the onset of the COVID-19 (COronaVIrus Disease 19) pandemic, SARS-CoV-2 has exhibited a high transmission rate, further enhanced by new variants able to better adapt to humans. Addressing this issue has been challenging due to viral resistance and side effects associated with antiviral drugs and vaccines. As a result, there has been a growing interest in plant-derived compounds with antiviral properties. Our study revealed that pistachio extracts significantly inhibited SARS-CoV-2 viral entry. Employing pseudotyped particles bearing the S protein of SARS-CoV-2, we demonstrated that treatment with pistachio extracts inhibited binding of alpha (α) and omicron (ο) SARS-CoV-2 variants. Furthermore, our study revealed that the pistachio carotenoid zeaxanthin exhibited a different inhibitory activity against two SARS-CoV-2 variants. In silico analyses demonstrated a strong interaction between zeaxanthin and the receptor-binding domain (RBD) domain of the omicron spike (S) protein, thus reducing pseudovirus entry. However, zeaxanthin’s weaker interaction with the alpha variant’s RBD was insufficient to inhibit entry. Additionally, zeaxanthin suppressed the expression of the host protease TMPRSS2 at the protein level, thereby limiting the internalization of the alpha variant, which relies on TMPRSS2 for cellular entry. Full article