Post-COVID-19 Symptoms and Conditions Among Children and Adolescents - United States, March 1, 2020-January 31, 2022.

Post-COVID-19 (post-COVID) symptoms and conditions* are new, recurring, or ongoing health problems that occur 4 or more weeks after infection with SARS-CoV-2 (the virus that causes COVID-19). Previous studies have characterized and estimated the incidence of post-COVID conditions among adults (1,2), but data among children and adolescents are limited (3-8). Using a large medical claims database, CDC assessed nine potential post-COVID signs and symptoms (symptoms) and 15 potential post-COVID conditions among 781,419 U.S. children and adolescents aged 0-17 years with laboratory-confirmed COVID-19 (patients with COVID-19) compared with 2,344,257 U.S. children and adolescents without recognized COVID-19 (patients without COVID-19) during March 1, 2020-January 31, 2022. The analysis identified several symptoms and conditions with elevated adjusted hazard ratios among patients with COVID-19 (compared with those without). The highest hazard ratios were recorded for acute pulmonary embolism (adjusted hazard ratio [aHR] = 2.01), myocarditis and cardiomyopathy (1.99), venous thromboembolic event (1.87), acute and unspecified renal failure (1.32), and type 1 diabetes (1.23), all of which were rare or uncommon in this study population. Conversely, symptoms and conditions that were most common in this study population had lower aHRs (near or below 1.0). Patients with COVID-19 were less likely than were patients without to experience respiratory signs and symptoms, symptoms of mental conditions, muscle disorders, neurological conditions, anxiety and fear-related disorders, mood disorders, and sleeping disorders. COVID-19 prevention strategies, including vaccination for all eligible children and adolescents, are critical to prevent SARS-CoV-2 infection and subsequent illness, including post-COVID symptoms and conditions (9).

Strategies for Strengthening Ethics Education in a DNP Program.

Nurse practitioners frequently encounter ethical dilemmas, and their identification is essential to effective resolution. An innovative approach involving collaboration between doctor of nursing practice (DNP) and doctor of philosophy (PhD) faculty was used to address this need in a graduate nursing program. The results included a broader understanding of the synergy of the two educational backgrounds in translating and delivering evidence-based practices. The development and use of realistic case studies was a teaching strategy for ethics education. The unique backgrounds of each faculty member promote ethical practice among DNP students, which is essential to the profession.

Ingestion and sublethal effects of physically and chemically dispersed crude oil on marine planktonic copepods.

Planktonic copepods play a key function in marine ecosystems, however, little is known about the effects of dispersants and chemically dispersed crude oil on these important planktonic organisms. We examined the potential for the copepods Acartia tonsa, Temora turbinata and Parvocalanus crassirostris to ingest crude oil droplets and determined the acute toxicity of the dispersant Corexit(®) 9500A, and physically and chemically dispersed crude oil to these copepods. We detected ingestion of crude oil droplets by adults and nauplii of the three copepod species. Exposure to crude oil alone (1 µL L(-1), 48 h) caused a reduction of egg production rates (EPRs) by 26-39 %, fecal pellet production rates (PPRs) by 11-27 %, and egg hatching (EH) by 1-38 % compared to the controls, depending on the species. Dispersant alone (0.05 µL L(-1), 48 h) produced a reduction in EPR, PPR and EH by 20-35, 12-23 and 2-11 %, respectively. Dispersant-treated crude oil was the most toxic treatment, ~1.6 times more toxic than crude oil alone, causing a reduction in EPR, PPR and EH by 45-54, 28-41 and 11-31 %, respectively. Our results indicate that low concentrations of dispersant Corexit 9500A and chemically dispersed crude oil are toxic to marine zooplankton, and that the ingestion of crude oil droplets by copepods may be an important route by which crude oil pollution can enter marine food webs.

Appropriateness of Immunoglobulin M Testing for Measles, Mumps, and Rubella.

INTRODUCTION: Testing for immunity to measles, mumps, and rubella should include only immunoglobulin G (IgG); immunoglobulin M (IgM) testing is appropriate only if acute illness is suspected. The appropriateness of measles, mumps, and rubella IgM testing was evaluated in a national administrative dataset. METHODS: Laboratory testing for measles, mumps, and rubella during 2019-2022 was analyzed in 2024 using HealthVerity administrative claims and laboratory data. IgG, IgM, and reverse-transcriptase polymerase chain reaction (RT-PCR) testing are described by year, demographics, and region. IgM testing was examined for appropriateness, defined as an IgM test combined with diagnostic codes indicative of acute illness. RESULTS: During 2019-2022, IgM testing represented a small proportion of serologic testing (measles: 3.3%, mumps: 2.4%, rubella: 2.1%) but appeared to be appropriately performed in only 15.4% of cases for measles, 32.8% of cases for mumps, and 10.2% of cases for rubella. IgM testing was more commonly performed for female patients, with the largest discrepancy seen for rubella (90.5% female vs 9.5% male). IgM for measles and mumps was more often performed appropriately for persons aged 0-19 years (37.6% and 60.1%) compared with persons aged 20-49 years (11.8% and 22.0%) and 50+ years (16.5% and 33.8%). CONCLUSIONS: The majority of IgM testing for measles, mumps, and rubella during this period appeared inappropriate. Clinicians and health systems could ensure that IgG testing alone is performed when evaluating for immunity through modifications to electronic medical records and commercial laboratories could ensure that providers are able to test for IgG alone when evaluating immunity.

Pyronaridine exerts potent cytotoxicity on human breast and hematological cancer cells through induction of apoptosis.

The potent antimalarial drug pyronaridine (PND) was tested for its potential as an anticancer drug. After exposing cancerous (17) and non-cancerous (2) cells to PND for 72 hr, PND was found to exhibit consistent and potent cytotoxic activity at low micromolar (µM) concentrations that ranged from 1.6 µM to 9.4 µM. Moreover, PND exerted a significant selective cytotoxicity index (SCI) on five out of seven breast cancer cell lines tested, with favorable values of 2.5 to 4.4, as compared with the non-cancerous breast MCF-10A cell line. By using the same comparison, PND exhibited a significant SCI on three out of four leukemia/lymphoma cell lines with promising values of 3.3 to 3.5. One breast cancer and one leukemia cell line were tested further in order to determine the likely mode of action of PND. PND was found to consistently elicit phosphatidylserine externalization, mitochondrial depolarization, and DNA fragmentation, in both the triple negative MDA-MB-231 breast cancer and HL-60 leukemia cell lines. In addition, PND treatment altered cell cycle progression in both cancer cells. Subsequent DNA mobility-shift assays, UV-Visible spectroscopic titrations, and circular dichroism (CD) experiments revealed that PND intercalates with DNA. The findings presented in this study indicates that PND induces apoptosis and interfered with cell cycle progression of cancer cell lines and these results indicate that this drug has the potential as a repurposed drug for cancer therapy.

Use of non-selective ß-blockers is associated with decreased tumor proliferative indices in early stage breast cancer.

Previous studies suggest beta-adrenergic receptor (ß-AR) antagonists (ß-blockers) decrease breast cancer progression, tumor metastasis, and patient mortality; however the mechanism for this is unknown. Immunohistochemical analysis of normal and malignant breast tissue revealed overexpression of ß1-AR and ß3-AR in breast cancer. A retrospective cross-sectional study of 404 breast cancer patients was performed to determine the effect of ß-blocker usage on tumor proliferation. Our analysis revealed that non-selective ß-blockers, but not selective ß-blockers, reduced tumor proliferation by 66% (p < 0.0001) in early stage breast cancer compared to non-users. We tested the efficacy of propranolol on an early stage breast cancer patient, and quantified the tumor proliferative index before and after treatment, revealing a propranolol-mediated 23% reduction (p = 0.02) in Ki67 positive tumor cells over a three-week period. The anti-proliferative effects of ß-blockers were measured in a panel of breast cancer lines, demonstrating that mammary epithelial cells were resistant to propranolol, and that most breast cancer cell lines displayed dose dependent viability decreases following treatment. Selective ß-blockers alone or in combination were not as effective as propranolol at reducing breast cancer cell proliferation. Molecular analysis revealed that propranolol treatment of the SK-BR-3 breast cancer line, which showed high sensitivity to beta blockade, led to a reduction in Ki67 protein expression, decreased phosphorylation of the mitogenic signaling regulators p44/42 MAPK, p38 MAPK, JNK, and CREB, increased phosphorylation of the cell survival/apoptosis regulators AKT, p53, and GSK3ß. In conclusion, use of non-selective ß-blockers in patients with early stage breast cancer may lead to decreased tumor proliferation.

Influence of UVB radiation on the lethal and sublethal toxicity of dispersed crude oil to planktonic copepod nauplii.

Toxic effects of petroleum to marine zooplankton have been generally investigated using dissolved petroleum hydrocarbons and in the absence of sunlight. In this study, we determined the influence of natural ultraviolet B (UVB) radiation on the lethal and sublethal toxicity of dispersed crude oil to naupliar stages of the planktonic copepods Acartia tonsa, Temora turbinata and Pseudodiaptomus pelagicus. Low concentrations of dispersed crude oil (1 µL L(-1)) caused a significant reduction in survival, growth and swimming activity of copepod nauplii after 48 h of exposure. UVB radiation increased toxicity of dispersed crude oil by 1.3-3.8 times, depending on the experiment and measured variables. Ingestion of crude oil droplets may increase photoenhanced toxicity of crude oil to copepod nauplii by enhancing photosensitization. Photoenhanced sublethal toxicity was significantly higher when T. turbinata nauplii were exposed to dispersant-treated oil than crude oil alone, suggesting that chemical dispersion of crude oil may promote photoenhanced toxicity to marine zooplankton. Our results demonstrate that acute exposure to concentrations of dispersed crude oil and dispersant (Corexit 9500) commonly found in the sea after oil spills are highly toxic to copepod nauplii and that natural levels of UVB radiation substantially increase the toxicity of crude oil to these planktonic organisms. Overall, this study emphasizes the importance of considering sunlight in petroleum toxicological studies and models to better estimate the impact of crude oil spills on marine zooplankton.

Tumor-selective cytotoxicity of a novel pentadiene analogue on human leukemia/ lymphoma cells.

BACKGROUND: A novel series of structurally divergent 1,5-diaryl-3-oxo-1,4-pentadiene analogues 1-10 displayed marked cytotoxic potencies towards a number of human leukemia/lymphoma cells. OBJECTIVE: To identify novel selective cytotoxic compounds that induce apoptosis. METHODS: The Differential Nuclear Staining (DNS) screening protocol was utilized to measure the cytotoxicity of all experimental dienones on several cancerous cells. Additionally, the selective cytotoxicity index was calculated by comparing the dienone's cytotoxicity between leukemia/lymphoma cells vs. non-cancerous cells. Furthermore, to discern whether a selected dienone induced cell death via apoptosis or necrosis on T-lymphocyte leukemia cells, diverse approaches were utilized to detect individual biochemical facets of apoptosis. RESULTS: The dienones were tested for their anti-neoplastic efficiency on human leukemia/lymphoma-derived cell lines. Special emphasis was applied on dienone 1, on the basis of its sub-micromolar cytotoxicity (CC50=0.43+0.02 µM) and high selective cytotoxicity index (11.1) exerted on T-leukemia cells. In general, dienone 1 showed the most potent cytotoxic properties as compared to other dienones and a related reference cytotoxin curcumin as well as the EF-24 curcumin analogue. Dienone 1 caused cell death by apoptosis in Jurkat cells as evidenced by inducing phosphatidylserine externalization, mitochondrial depolarization and caspase-3/7. These effects were mainly attributed to the induction of apoptotic pathways. CONCLUSION: The novel dienone 1 was found to exhibit potent anti-leukemia activity by inducing programmed cell death/apoptosis. Consequently, dionone 1 should be developed further to examine its potential efficacy to combat malignancies in a pre-clinical animal model.

Lethal and sublethal effects of selected PPCPs on the freshwater rotifer, Plationus patulus.

Pharmaceuticals and personal care products (PPCPs) have been reported in surface waters around the world. The continuous input of these pollutants into freshwaters and their potential effects on aquatic life are of increasing concern. The rotifer Plationus patulus, a basal member of riverine food webs, was used to test acute and chronic toxicity of 4 PPCPs (acetamidophenol, caffeine, fluoxetine, triclosan). A population from a remote site in Mexico (reference population) and one from an urbanized stretch of the Rio Grande were exposed. Acute toxicity tests show that both populations were more sensitive to fluoxetine. Chronic exposure to acetamidophenol (10 mg/L, 15 mg/L, and 20 mg/L) inhibited reference population growth, whereas Rio Grande population growth was inhibited only at 15 mg/L and 20 mg/L. Population growth was inhibited at 200 mg/L and 300 mg/L of caffeine for both populations. Chronic exposure to fluoxetine (0.020 mg/L) significantly inhibited population growth for the Rio Grande population only. Triclosan (0.05 mg/L, 0.075 mg/L, 0.10 mg/L) had the most deleterious effects, significantly reducing both populations' growth rates. Sublethal effects of chronic exposure to PPCPs included decreased egg production and increased egg detachment. A mixed exposure (6 PPCPs, environmentally relevant concentrations) did not affect population growth in either population. However, the continuous introduction of a broad suite of PPCPs to aquatic ecosystems still may present a risk to aquatic communities. Environ Toxicol Chem 2015;34:913-922. © 2014 SETAC.