Choroiditis following severe acute respiratory syndrome coronavirus 2 infection in unvaccinated identical twins

ABSTRACT Unvaccinated identical twins developed bilateral anterior uveitis soon after the onset of coronavirus disease 2019 symptoms. During follow-up, both patients developed choroiditis, and one twine developed posterior scleritis and serous retinal detachment. Prompt treatment with oral prednisone ameliorated the lesions, and no recurrence was observed at the 18-month follow-up. Choroiditis may rarely be associated with severe acute respiratory syndrome coronavirus 2 infection, and it responds well to corticosteroid therapy. Although the exact mechanism is unknown, we hypothesize that the virus may act as an immunological trigger for choroiditis.

Prevalência de Influenza A, vírus sincicial respiratório eSARS-CoV-2 em pacientes com síndrome respiratóriaaguda grave em Passo Fundo, Rio Grande do Sul / Prevalence of Influenza A, respiratory syncytial virus andSARS-CoV-2 in patients with severe acute respiratorysyndrome in Passo Fundo, Rio Grande do Sul

A síndrome respiratória aguda grave (SRAG) é caracterizada por sintomas de febre alta, tosse e dispneia, e, na maioria dos casos, relacionada a uma quantidade reduzida de agentes infecciosos. O objetivo foi avaliar a prevalência dos vírus respiratórios Influenza A (FluA), vírus sincicial respiratório (RSV) e do novo coronavírus (SARS-CoV-2) em pacientes com internação hospitalar por SRAG. Estudo transversal, com pacientes em internação hospitalar com SRAG entre novembro de 2021 e maio de 2022. Dados sociodemográficos e clínicos e amostras da nasofaringe foram coletados/as, as quais foram submetidas à extração de RNA e testadas quanto à positividade para Influenza A, RSV e SARS-CoV-2 por meio da técnica de PCR em tempo real pelo método SYBR Green. Foram incluídos 42 pacientes, sendo 59,5% do sexo feminino, 57,1% idosos, 54,8% com ensino fundamental. A maior parte dos pacientes reportou hábito tabagista prévio ou atual (54,8%), não etilista (73,8%) e 83,3% deles apresentavam alguma comorbidade, sendo hipertensão arterial sistêmica e diabetes mellitus tipo 2 as mais prevalentes. Um total de 10,5% dos pacientes testou positivo para FluA, nenhuma amostra positiva para RSV e 76,3% positivos para SARS-CoV-2. Na população estudada, SRAG com agravo hospitalar foi observado em maior proporção, em mulheres, idosos e pessoas com comorbidades, embora sem significância estatística, sendo o novo coronavírus o agente etiológico mais relacionado, o que evidencia a patogenicidade desse agente e suas consequências ainda são evidentes após quase 2 anos de período pandêmico.

Severe acute respiratory syndrome (SARS) is characterized by symptoms of high fever, cough and dyspnea, and is in most cases related to a reduced amount of infectious agents. The objective was to assess the prevalence of respiratory viruses Influenza A (FluA), respiratory syncytial virus (RSV) and the new coronavirus (SARS-CoV-2) in patients hospitalized for SARS. Cross-sectional study, with patients hospitalized with SARS between November 2021 and May 2022. Sociodemographic and clinical data and nasopharyngeal samples were collected, which were subjected to RNA extraction and tested for positivity for Influenza A, RSV and SARS-CoV-2 using the real-time PCR technique using the SYBR Green method. 42 patients were included, 59.5% female, 57.1% elderly, 54.8% with primary education. Most patients reported previous or current smoking habits (54.8%), non-drinkers (73.8) and 83.3% of them had some comorbidity, with systemic arterial hypertension and type 2 diabetes mellitus being the most prevalent. A total of 10.5% of patients tested positive for FluA, no samples positive for RSV, and 76.3% positive for SARS-CoV-2. In the studied population, SARS with hospital injury was observed more frequently in women and the elderly, with associated comorbidities, with the new coronavirus being the most related etiological agent, which shows, although not statistically significant, that the pathogenicity of this agent and its consequences are still evident after almost 2 years of period pandemic.

Estresse percebido e sofrimento psíquico em gestoresde saúde na pandemia da Covid-19 / Perceived stress and psychic suffering in healthmanagers in the Covid-19 pandemic

Objetivo: analisar o nível de estresse percebido e sofrimento psíquico em gestores de saúde na pandemia da Covid-19. Método: estudo descritivo, transversal com abordagem quantitativa. A coleta ocorreu de abril a setembro de 2021, com 40 gestores de serviço de saúde. Utilizou-se para a coleta de dados um instrumento para caracterização sociodemográfica e ocupacional e as escalas "Perceived Stress Scale-14" e "Self Reporting Questionnaire" para avaliação do estresse percebido e sofrimento psíquico. Os dados coletados foram analisados no Statistical Package for the Social Sciences versão 22.0. O presente estudo faz parte de um projeto intitulado "Trabalhadores dos Serviços de Saúde Frente à Pandemia de Covid-19", aprovado pelo Comitê de Ética em Pesquisa sob CAAE número 35260620.9.0000.5231. Resultados: a maioria dos profissionais eram do sexo feminino (90%, N=36), casados (70%, N=28), com filhos (80%, N=32), com média de idade de 45 anos e com pós--graduação (47,5%, N=19). A média dos escores relacionados ao estresse percebido foi 31,13 pontos (DP=3,77) sendo o mínimo 24 e máximo de 42 pontos. Com relação ao sofrimento psíquico, (40%, N=16) os gestores apresentaram prováveis casos de transtornos. A prática de atividades físicas e de lazer (p<0,05) tem papel importante na diminuição do estresse percebido e do sofrimento psíquico. Conclusão: os gestores em saúde apresentaram, durante a pandemia, estresse e sofrimento psíquico, resultados esses que devem ser considerados para promoção de autocuidado aos gestores de saúde, enfatizando a necessidade da realização de atividades físicas e de lazer.

Objective: to analyze the level of perceived stress and psychological suffering in health managers during the Covid-19 pandemic. Method: descriptive, cross-sectional study with a quantitative approach. The collection took place from April to September 2021, with 40 health service managers. An instrument for socio-demographic and occupational characterization and the "Perceived Stress Scale-14" and "Self Reporting Questionnaire" scales were used for the assessment of perceived stress and psychic suffering. The collected data were analyzed using the Statistical Package for the Social Sciences version 22.0. The present study is part of a project entitled "Health Service Workers in the Face of the Covid-19 Pandemic", approved by the Research Ethics Committee under CAAE number 35260620.9.0000.5231. Results: most professionals were female (90%, N=36), married (70%, N=28), with children (80%, N=32), with a mean age of 45 years and with a postgraduate degree. -graduation (47.5%, N=19). The average score related to perceived stress was 31.13 points (SD=3.77), with a minimum of 24 and a maximum of 42 points. With regard to psychic suffering, (40%, N=16) the managers presented probable cases of disorders. The practice of physical and leisure activities (p<0.05) plays an important role in reducing perceived stress and psychological distress. Conclusion: health managers presented, during the pandemic, stress and psychic suffering, results that should be considered for promoting self-care to health managers, emphasizing the need to carry out physical and leisure activities.Keywords: Health manager; Occupational stress; Covid-19; Coronavirus infections.

Synthesis and evaluation of N-arylindazole-3-carboxamide derivatives as novel antiviral agents against SARS-CoV-2.

N-Arylindazole-3-carboxamide derivatives synthesized from an anti-MERS-CoV hit compound showed potent inhibitory activities against SARS-CoV-2. Among them, 5-chloro-N-(3,5-dichlorophenyl)-1H-indazole-3-carboxamide (4a) exhibited a potent inhibitory effect (EC50 = 0.69 µM), low cytotoxicity, and satisfactory in vitro PK profiles. Thus, N-arylindazole-3-carboxamide 4a provides a novel template for future development of anti-coronavirus agents.

AMP kinase: A promising therapeutic drug target for post-COVID-19 complications.

The COVID-19 pandemic, caused by SARS-CoV-2, has resulted in severe respiratory issues and persistent complications, particularly affecting glucose metabolism. Patients with or without pre-existing diabetes often experience worsened symptoms, highlighting the need for innovative therapeutic approaches. AMPK, a crucial regulator of cellular energy balance, plays a pivotal role in glucose metabolism, insulin sensitivity, and inflammatory responses. AMPK activation, through allosteric or kinase-dependent mechanisms, impacts cellular processes like glucose uptake, fatty acid oxidation, and autophagy. The tissue-specific distribution of AMPK emphasizes its role in maintaining metabolic homeostasis throughout the body. Intriguingly, SARS-CoV-2 infection inhibits AMPK, contributing to metabolic dysregulation and post-COVID-19 complications. AMPK activators like capsaicinoids, curcumin, phytoestrogens, cilostazol, and momordicosides have demonstrated the potential to regulate AMPK activity. Compounds from various sources improve fatty acid oxidation and insulin sensitivity, with metformin showing opposing effects on AMPK activation compared to the virus, suggesting potential therapeutic options. The diverse effects of AMPK activation extend to its role in countering viral infections, further highlighting its significance in COVID-19. This review explores AMPK activation mechanisms, its role in metabolic disorders, and the potential use of natural compounds to target AMPK for post-COVID-19 complications. Also, it aims to review the possible methods of activating AMPK to prevent post-COVID-19 diabetes and cardiovascular complications. It also explores the use of natural compounds for their therapeutic effects in targeting the AMPK pathways. Targeting AMPK activation emerges as a promising avenue to mitigate the long-term effects of COVID-19, offering hope for improved patient outcomes and a better quality of life.

Identification of adenosine analogues as nsp14 N7­methyltransferase inhibitors for treating coronaviruses infection.

Coronaviruses are RNA viruses that have coevolved with humans and animals over time, exhibiting high mutation rates and mortality rates upon epidemic outbreaks. The nonstructural protein (nsp14) is crucial for various coronaviruses processes, including genome replication, protein translation, virus particle assembly, and evasion of host immunity via RNA methylation modification. In this study, a series of adenosine analogs were designed, synthesized, and evaluated for their inhibitory activities. Among them, MTI013 exhibited the strongest nsp14 MTase inhibition and antiviral activity, with an IC50 of 10.33 µM in HCoV-229E-infected Huh7 cells, along with low cytotoxicity. When combined with the RdRp inhibitor ATV014, MTI013 showed a synergistic antiviral effect, indicating its potential both as a standalone therapy and in combination treatments. Furthermore, MTI013 displayed high selectivity against the SARS-CoV-2 nsp10-nsp16 complex and five human methyltransferases. These results offer valuable structural insights for future exploration of nsp14 as a drug target for SARS-CoV-2 and other coronaviruses.

Predictive significance of hypertension in the incidence of complications in critically ill patients with COVID­19: A retrospective cohort study.

The association between hypertension as a pre-existing comorbidity and the severe form of coronavirus disease 2019 (COVID-19) remains unclear due to the contradictory results of previously published studies. The present study evaluated the predictive significance of hypertension in the incidence of complications among critically ill patients with COVID-19. The present study included 372 critically ill adults with COVID-19 pneumonia, hospitalized between January 1 and December 31, 2021. The study cohort was divided into the hypertension group (HTA group), which included 245 patients with a history of hypertension, or a non-HTA group (control group), which included 127 patients without hypertension. The incidence of complications was retrospectively extracted from medical records and compared between groups. Multivariate regression analysis (adjusted for potential confounders) and receiver operating characteristic (ROC) curve analysis determined the predictive significance of hypertension on the incidence of complications. The patients in the HTA group were more likely to receive invasive mechanical ventilation [odds ratio (OR), 1.696; P<0.02], develop sepsis (OR, 1.807; P<0.01) and develop complications (OR, 3.101; P<0.001). Hypertension was an independent positive predictor for invasive mechanical ventilation [area under the curve (AUC), 0.67; positive predictive value (PPV), 71.7%; P<0.05], sepsis (AUC, 0.69; PPV, 77.5%; P<0.026) and total complications per patient (AUC, 0.71; PPV, 81.4%; P<0.001). On the whole, the data of the present study indicate that a history of hypertension should be considered as an independent clinical predictor of a higher incidence of complications in critically ill patients with COVID-19. Patients with pre-existing hypertension and a diagnosis of COVID-19 require timely identification, additional attention and treatment to avoid a critical course and help improve outcomes.

Is there a Possible Association between Multiple Myeloma Relapse and Coronavirus Disease 2019 Vaccination? A Case Report.

Due to the high morbidity and mortality of the coronavirus disease 2019 (COVID-19) in patients with malignancy, the necessity of vaccination in this group of patients became particularly important. Although a large number of studies have reported the safety of COVID-19 vaccination in multiple myeloma (MM) patients, the effect of the COVID-19 vaccine on MM relapse has not yet been reported. Here, we report a case of a possible association between relapse of MM and COVID-19 vaccination with Sinopharm®, an inactivated virus vaccine, in a patient with MM who has remained in complete remission for about 4 years. The MM relapse in the patient was diagnosed by both clinical findings and laboratory workup including serum protein electrophoresis, bone marrow aspiration, and biopsy. Despite this possible association between COVID-19 vaccination and MM relapse in the patient, given its importance in reducing mortality and having an acceptable safety profile, the COVID-19 vaccine should be administered to all cancer patients. However, careful monitoring and follow-up are recommended in patients with MM after COVID-19 vaccination.

Characteristics and outcomes of ICU-admitted COVID-19 patients in the Omicron and Alpha-dominated periods.

BACKGROUND: Comparing the outcomes of intensive care unit (ICU) admitted COVID-19 patients during the Alpha and Omicron-dominated periods. METHODS: Patients with critical COVID-19 disease, requiring ICU admission from May to September 2021 and February to August 2022, were enrolled from a single medical center in Northern Taiwan. Clinical demographics, comorbidities, disease severity, and management strategies were recorded. The 28-day mortality from the two periods were compared both in the original and propensity score (PS)-matched cohort. RESULTS: Of 231 patients, 72 (31.2%) were from the Alpha period and 159 (68.8%) from the Omicron period. Patients in the Omicron period were older, had a lower body mass index, more comorbidities, higher disease severities, and increased 28-day mortality (26.4% vs. 13.9%, p = 0.035). In multivariable analysis, the Omicron-dominated period was not identified as an independent factor associated with increased 28-day mortality. COVID-19 patients in Alpha- and Omicron-dominated periods had comparable 28-day mortality in PS-matched cohort (12.1% vs. 18.2%, p = 0.733). Independent factors associated with 28-day mortality were a lower PF ratio (PF ratio <100, adjusted odds ratio [aOR] 2.68, 95% confidence interval, CI 1.21-5.94), septic shock ([aOR] 2.39, 95% CI 1.12-5.09) and absence of remdesivir ([aOR] 0.36, 95% CI 0.16-0.83). CONCLUSION: While patients in the Omicron period exhibited greater severity, the variant was not independently linked to higher 28-day mortality in ICU-admitted patients.

Preferential cleavage of the coronavirus defective viral genome by cellular endoribonuclease with characteristics of RNase L.

In testing whether coronavirus defective viral genome 12.7 (DVG12.7) with transcription regulating sequence (TRS) can synthesize subgenomic mRNA (sgmRNA) in coronavirus-infected cells, it was unexpectedly found by Northern blot assay that not only sgmRNA (designated sgmDVG 12.7) but also an RNA fragment with a size less than sgmDVG 12.7 was identified. A subsequent study demonstrated that the identified RNA fragment (designated clvDVG) was a cleaved RNA product originating from DVG12.7, and the cleaved sites were located in the loop region of stem‒loop structure and after UU and UA dinucleotides. clvDVG was also identified in mock-infected HRT-18 cells transfected with DVG12.7 transcript, indicating that cellular endoribonuclease is responsible for the cleavage. In addition, the sequence and structure surrounding the cleavage sites can affect the cleavage efficiency of DVG12.7. The cleavage features are therefore consistent with the general criteria for RNA cleavage by cellular RNase L. Furthermore, both the cleavage of rRNA and the synthesis of clvDVG were also identified in A549 cells. Because (i) the cleavage sites occurred predominantly after single-stranded UA and UU dinucleotides, (ii) the sequence and structure surrounding the cleavage sites affected the cleavage efficiency, (iii) the cleavage of rRNA is an index of the activation of RNase L, and (iv) the cleavage of both rRNA and DVG12.7 was identified in A549 cells, the results together indicated that the preferential cleavage of DVG12.7 is correlated with cellular endoribonuclease with the characteristics of RNase L and such cleavage features have not been previously characterized in coronaviruses.

Mini Nutritional Assessment Short Form as a predictor of mortality among older adults with dementia residing in group homes: A 5-year longitudinal study.

BACKGROUND & AIMS: Many people with dementia frequently experience various health-related problems and are known to have poor nutritional status. However, very few studies have examined the nutritional status of dementia residents in group homes, which play an important role in a society-wide system of support for people with dementia, or the relationship between nutritional status and long-term prognosis. This study was conducted to determine the nutritional status of group-home residents and to examine the relationship between nutritional status and the 5-year survival rate. METHODS: Participant characteristic (e.g., age, sex, body mass index, and medical history) and Mini Nutritional Assessment-Short Form (MNA-SF), Barthel index (BI), and Clinical Dementia Rating (CDR) data were collected from 79 older people (12 men/67 women; mean age: 88.3 ± 5.5 years) residing in 5 group homes as a baseline survey. Mortality data were obtained from medical records using an endline survey. RESULTS: The nutritional status of the participants using the MNA-SF was normal, at risk of malnutrition, and malnourished in 15.2% (n = 12), 69.6% (n = 55), and 15.2% (n = 12) of participants, respectively. Following the survey, mortality data were collected for 5 years, and the 5-year survival rates were 64.3% in those with normal nutritional status, 30.4% in those at risk of malnutrition, and 9.1% in the malnourished group, with a significant difference observed in the Kaplan-Meier analysis (p < 0.001). The hazard ratio for the MNA-SF scores and survival rates adjusted for sex, age, BI, and CDR were significant 0.80 [0.69-0.93, p = 0.003]. CONCLUSION: This study showed that 84.8% of patients with dementia residing in group homes were malnourished or at risk of malnutrition and that low MNA-SF levels were an independent determinant of the 5-year survival rate.

Vaccine-induced reduction of COVID-19 clusters in school settings in Japan during the epidemic wave caused by B.1.1.529 (Omicron) BA.2, 2022.

Clusters of COVID-19 in high-risk settings, such as schools, have been deemed a critical driving force of the major epidemic waves at the societal level. In Japan, the vaccination coverage among students remained low up to early 2022, especially for 5-11-year-olds. The vaccination of the student population only started in February 2022. Given this background and considering that vaccine effectiveness against school transmission has not been intensively studied, this paper proposes a mathematical model that links the occurrence of clustering to the case count among populations aged 0-19, 20-59, and 60+ years of age. We first estimated the protected (immune) fraction of each age group either by infection or vaccination and then linked the case count in each age group to the number of clusters via a time series regression model that accounts for the time-varying hazard of clustering per infector. From January 3 to May 30, 2022, there were 4,722 reported clusters in school settings. Our model suggests that the immunity offered by vaccination averted 226 (95% credible interval: 219-232) school clusters. Counterfactual scenarios assuming elevated vaccination coverage with faster roll-out reveal that additional school clusters could have been averted. Our study indicates that even relatively low vaccination coverage among students could substantially lower the risk of clustering through vaccine-induced immunity. Our results also suggest that antigenically updated vaccines that are more effective against the variant responsible for the ongoing epidemic may greatly help decrease not only the incidence but also the unnecessary loss of learning opportunities among school-age students.

The Impact of the COVID-19 Pandemic on Waist and Hip Circumference and Selected Indicators Related to It Among Adolescents From the Kraków (Poland) Population.

OBJECTIVES: The aim of the study was to assess changes in waist and hip circumference, as well as the waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) indices among adolescents (11-15-year-olds) from the Kraków during the COVID-19 pandemic. METHODS: Cross-sectional studies were conducted in four main districts of the city in the years 2020 and 2022. The study group consisted of 1662 people. Measurements of height, waist circumference, and hip circumference were taken. The collected data were used to calculate the WHR and WHtR indices. Statistical analyses were performed using two-way ANOVA and post hoc Tukey's test, as well as the Kruskal-Wallis test, depending on the normality of distribution. RESULTS: An increase in hip circumference was observed in most age groups of both sexes. Among 14-15-year-old boys, an increase in waist circumference was observed, while among girls, the majority of cohorts showed the opposite trend. Additionally, in most age groups, a decrease in the values of WHR and WHtR indices was observed in both sexes, except for boys aged 14-15. CONCLUSION: The study found that government-imposed restrictions related to the COVID-19 pandemic had an impact on waist circumference, hip circumference, WHR, and WHtR indicators among adolescents aged 11-15 from Kraków. While some results showed regression, suggesting potential factors such as reduced physical activity or increased screen time contributing to deteriorating outcomes. On the other hand, not all results changed, which may be attributed to the absence of modifications in dietary habits or physical activity as government restrictions ceased.

Lateral effects of infection prevention measures during COVID-19 pandemic on hospital-acquired Clostridioides difficile infection.

Background: Systematic surveillance of Clostridioides difficile infection (CDI) in our institution showed a reduction in the incidence of healthcare associated CDI (HA-CDI) during COVID-19 pandemic. Aim: Our objective was to search for factors related to this reduction. Methods: We retrospectively studied the trend of the incidences of HA-CDI, Multidrug Resistant (MDR) organisms, total antibiotic and chlorine consumptions as well as the influence of the last two on the incidence of HA-CDI. Results: During COVID-19 pandemic, the HA-CDI incidence was reduced with respect to the previous years, although total antibiotic consumption was found to increase (p < .01). MDR organisms' incidence was found to increase (p < .01), as well as the chlorine consumption (p = .04) which was the only factor to be related to the decreased rates of HA-CDI (r = -0.786, p < .05). Discussion: In our institution, COVID-19 epidemic overlapped with the reduction in the HA-CDI's incidence. This could be due to faithful compliance with the contact precaution measures but then, we would expect the incidence of MDR organisms to decrease as well. Chlorine usage for environmental cleaning was generalized during pandemic. It was the only factor to be related to the decreased rates of HA-CDI, highlighting the importance of environmental cleaning as a measure for HA-CDI prevention.

Yearly motor function changes in patients with Duchenne muscular dystrophy, including a COVID-19 behavioral restriction period.

[Purpose] This study aimed to assess the motor function status of ambulatory patients with Duchenne muscular dystrophy in 2020, which included a 3-month period of behavioral restriction due to the coronavirus disease of 2019 (COVID-19) pandemic, in comparison to the previous 2 years. [Participants and Methods] A retrospective analysis was conducted on 12 patients (children with mean age: 9.58 ± 3.43 years in 2020). Parameters such as lower leg maximum circumference, 10-m running time, rising-from-the-floor time, ankle joint range-of-motion, 6-min walk distance, and North Star Ambulatory Assessment score were evaluated. [Results] Significant increases in the maximum right thigh circumference and prolonged 10-m running time were observed in 2020. Interestingly, an unexpected improvement in ankle dorsiflexion angle was noted in both ankles. No other statistically significant differences were observed among the assessed time points. [Conclusion] These findings highlight the critical importance of continuous exercise and rehabilitation for ambulatory children with Duchenne muscular dystrophy, emphasizing the potential of rehabilitation to mitigate and restore the transient motor function deterioration observed during periods of behavioral restrictions.

Exploring the linkage between health technology assessment and decision making during COVID-19 public health emergency in a developing country: analysis of processes and results.

OBJECTIVES: The decision-making (DM) process in public administration is the subject of research from different perspectives and disciplines. Evidence-based policies, such as health technology assessment (HTA), are not the only support on which public policies are designed. During the COVID-19 pandemic WHO, national and subnational institutions developed HTA reports to guide DM. Despite this, inadequate variability was observed in the health technologies recommended and reimbursed by different provincial Health Ministries in a federally organized developing country like Argentina. The processes and results of DM on health technologies for COVID-19 in Health Ministries of Argentina were inquired. METHODS: A retrospective research design was developed, with triangulation of quantitative and qualitative methods. We retrieved information for the years 2020-2021 through document review of official webpages, surveys, and interviews with decision-makers of the 25 Argentinian Ministries of Health. We analyzed the recommendations and reimbursement policies of seven health technologies. RESULTS: In contradiction with WHO's policies, ivermectine, inhaled ibuprofen, convalescent plasma and equine serum were widely recommended by most of Argentina's health ministries outside a clinical trial context, with risks for patients and a huge opportunity cost. CONCLUSIONS: Despite an important HTA institutional capacity, the impact of HTA organizations and their technical reports was limited. Health Ministries with institutionalized HTA units had more adherence to WHO recommendations, but the influence of different technical and political criteria was identified. Power relations within and outside the administration, the pharmaceutical industry and academics, the media, social pressure, the judicial and legislative powers, and the political context strongly influenced DM.

Cross-country comparison of depressive symptoms and social-emotional aspects in university students from Brazil and Germany during the COVID-19 pandemic: results from two cross-sectional surveys.

BACKGROUND: The COVID-19 pandemic negatively affected students' mental health, increasing pre-existing psychosocial vulnerabilities. University students worldwide have presented differences in their mental health status; however, cross-country studies comparing students' mental health during the pandemic are lacking. AIMS: To investigate potential differences between university students from Brazil and those from Germany with respect to (a) depressive symptoms and alcohol and drug consumption, (b) social and emotional aspects (loneliness, self-efficacy, perceived stress, social support and resilience) and (c) attitudes towards vaccination. METHOD: Two online cross-sectional studies were conducted with university students during the COVID-19 pandemic in Brazil (November 2021 to March 2022) and in Germany (April to May 2022). Depressive symptoms, alcohol consumption, loneliness, self-efficacy, perceived stress, social support, resilience, sociodemographic information and attitudes towards vaccination were assessed. Data were analysed using univariate and bivariate models. RESULTS: The total sample comprised N = 7911 university students, with n = 2437 from Brazil and n = 5474 from Germany. Brazilian students presented significantly more depressive symptoms and suicidal thoughts, higher levels of perceived stress, higher frequency of drug or substance consumption, and lower levels of perceived social support and resilience than German students, whereas German students presented higher levels of loneliness than Brazilian students. A more favourable opinion towards vaccinations in general was found among Brazilian students compared with German students. CONCLUSIONS: In both countries, low-threshold (online) counselling targeting university students is needed. The differences between the samples could indicate country and/or cultural differences which justify further research in this area.

Serum tumor necrosis factor-alpha status in hospitalized patients with coronavirus disease-2019 (COVID-19).

Background: Tumor necrosis factor alpha (TNF-α) produces an inflammatory process and plays a critical role against infection and in the control of viral infection. The present study was conducted to determine the status of serum TNF-α in hospitalized patients with coronavirus disease-2019 (COVID-19). Methods: In this cross-sectional study the serum TNF-α level, sex, and age, were determined in patients with COVID-19. The association between variables was determined using the student t-test, analysis of variance (ANOVA) test, multiple logistic regression analysis, and the statistical package for the Social Sciences (SPSS)-18 (p < 0.05). Results: A total of 91 (women 41.75%, and men 58.24%) patients with a mean serum TNF-α level of 9.9 picograms per milliliter (pg/mL) were considered. In all (100%) patients, the TNF-α serum level was more than the normal limit (P=0.95). 95.60% of patients suffered severe COVID-19, with a TNF-a serum level of 10.20 pg/mL (P=0.87). Mean TNF-α serum levels in women and men were 11.37 pg/mL and 8.8 pg/mL, respectively (P= 0.17). In the age group of > 70 years (11.30 pg/mL), serum TNF-α concentration was higher than the other age groups (p>0.05). Conclusion: A significant proportion of women and men patients with COVID-19 in the middle and old age had a high concentration of serum TNF-α which may indicate the severity of the disease. Serum TNF-α level is different in women and men of different ages, so it can contribute to treatment strategies.

Efficacy of vitamin D supplementation in the treatment of patients with COVID-19: a systematic review and meta-analysis of randomized controlled trials.

Context: COVID-19 has substantial effects on respiratory health and overall well-being. Recent studies suggest vitamin D as a potential treatment, but the results are inconclusive. Objective: The authors conducted a systematic review of randomized controlled trials (RCTs) to examine the link between vitamin D and patients with COVID-19. Data sources: The authors searched electronic databases PubMed, Cochrane, CINAHL, EMBASE and Google Scholar from their inception till August 2023. Study selection: Inclusion criteria used in our systematic review include: (1) patients who tested positive for COVID-19, (2) intervention was vitamin D supplementation, (3) the comparator was either a placebo, standard care of treatment, or, no treatment, (4) at least one of the clinical outcomes of interest were investigated, (5) study design being RCTs. Data extraction: Two independent reviewers manually extracted information from selected articles, including study characteristics, patient characteristics, and the primary outcomes: all-cause mortality, ICU and hospital stay length and secondary outcomes: mechanical ventilation, supplemental oxygen, ICU admission, and adverse events. Risk ratios or mean differences and 95% CIs were calculated using a random-effects model. Data synthesis: The authors' analysis included 14 RCTs with 2165 patients. Vitamin D significantly reduced ICU admissions and lowered the need for mechanical ventilation compared to placebo. However, it did not significantly affect hospital stay length, ICU stay length, mechanical ventilation duration, mortality, or the need for supplemental oxygen. Conclusion: Vitamin D does not significantly improve certain clinical outcomes, such as hospital and ICU stay length, for patients with COVID-19. However, it still may be significantly beneficial in decreasing the burden on intensive care services.