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Long COVID represents the constellation of post-acute and long-term health effects caused by SARS-CoV-2 infection; it is a complex, multisystem disorder that can affect nearly every organ system and can be severely disabling. The cumulative global incidence of long COVID is around 400 million individuals, which is estimated to have an annual economic impact of approximately $1 trillion—equivalent to about 1% of the global economy. Several mechanistic pathways are implicated in long COVID, including viral persistence, immune dysregulation, mitochondrial dysfunction, complement dysregulation, endothelial inflammation and microbiome dysbiosis. Long COVID can have devastating impacts on individual lives and, due to its complexity and prevalence, it also has major ramifications for health systems and economies, even threatening progress toward achieving the Sustainable Development Goals. Addressing the challenge of long COVID requires an ambitious and coordinated—but so far absent—global research and policy response strategy. In this interdisciplinary review, we provide a synthesis of the state of scientific evidence on long COVID, assess the impacts of long COVID on human health, health systems, the economy and global health metrics, and provide a forward-looking research and policy roadmap. This Review outlines the current state of scientific evidence on long COVID, discusses its impacts on patients, health systems, economies and global health metrics, and proposes a forward-looking research and policy roadmap.

In temperate regions, some avian haemosporidian parasites have evolved seasonal transmission strategies, with chronic infections relapsing during spring and transmission peaking during the hosts’ breeding season. Because lineages with seasonal transmission strategies are unlikely to produce gametocytes in winter, we predicted that (1) resident birds living within wintering areas of Neotropical migrants would unlikely be infected with North American parasite lineages; and (2) if infected, wintering migratory birds would be more likely to harbor Plasmodium spp. rather than Parahaemoproteus spp. or Haemoproteus spp. parasites in their bloodstreams, as only Plasmodium produces life stages, other than gametocytes, that infect red blood cells. To test these predictions, we used molecular detection and microscopy to compare the diversity and prevalence of haemosporidian parasites among year-round residents and wintering migratory birds during February 2016, on three islands of The Bahamas archipelago, i.e., Andros, Grand Bahama, and Great Abaco. Infection prevalence was low and comparable between migratory (15/111) and resident (15/129) individuals, and it did not differ significantly among islands. Out of the 12 lineages detected infecting migratory birds, five were transmitted in North America; four lineages could have been transmitted during breeding, wintering, or migration; and three lineages were likely transmitted in The Bahamas. Resident birds mostly carried lineages endemic to the Caribbean region. All North American–transmitted parasite lineages detected among migratory birds were Plasmodium spp. Our findings suggest that haemosporidian parasites of migrants shift resource allocation seasonally, minimizing the production of gametocytes during winter, with low risk of infection spillover to resident birds.

Bacterial resistance in foodborne pathogens is a global concern and has stimulated the search for alternative compounds to antimicrobials. In this context, the prevention of colonization by Salmonella spp. in poultry production is particularly important. This study investigated the bactericidal effect of lysozyme on Salmonella Heidelberg and Salmonella Minnesota. A total of 44 serotyped isolates were subjected to minimum inhibitory concentration (MIC) testing against 17 distinct antibiotics. Subsequently, the same isolates were subjected to minimal bactericidal concentration (MBC) with lysozyme at concentrations ranging from 15 to 2000 ppm. One strain of S. Heidelberg was selected for an in vivo challenge. Seventy-two male chicks were randomly divided into three experimental groups, and two of them were challenged on the second day with 0.5 mL of an inoculum containing 1 × 105 CFU/mL. One of these groups was treated with lysozyme at a concentration of 1000 ppm per bird for 21 days. MIC tests showed that the multidrug resistance rate was 97.72%, with susceptibility only to fosfomycin, florfenicol, and meropenem. After the in vitro exposure of these isolates to lysozyme, 86.36% were inhibited at concentrations ≤ 15 ppm. The in vivo tests showed a significant reduction in the total number of chickens colonized by S. Heidelberg at 2, 5, 7, 14, 18, and 21 days of farming. On the day of slaughter, the percentage of positive birds in the inoculated group was 63.63%, while that in the group treated with lysozyme was 26.08%. These data highlight the potential use of lysozyme as an alternative to antibiotics in poultry production.

Background Long COVID (LC) is a global health concern, affecting millions and placing significant strain on healthcare systems. However, there is a notable lack of LC research in low- and middle-income countries, particularly in the global south. This study aims to fill this gap by focusing on Brazil, a country with an emerging LC literature but limited population estimates due to sampling constraints. Our unique focus is to estimate the prevalence of persistent symptoms and LC self-reported diagnosis among COVID-19 patients hospitalized in Rio de Janeiro City public hospitals. We also aim to identify factors associated with the LC measures and most frequent symptoms, providing valuable insights for healthcare systems and policymakers. Methods We designed a comprehensive, patient-engaged cohort survey study to assess LC symptoms and administered it to a probability sample of adults six to 24 months post-discharge from public hospitals in Rio de Janeiro City. LC was measured as (i) at least one persistent symptom or (ii) self-reported LC. Among the symptoms, we considered post-exertional malaise, which is frequently neglected in LC studies. Additionally, we applied an adaptation of the DePaul Symptom Questionnaire to account not only for the presence but also the frequency of symptom occurrence. We estimate the prevalence of symptoms and use logistic regression models to identify associations between LC and the most frequent LC symptoms and independent variables, assessing demographic, socioeconomic, lifestyle, and clinical characteristics, vaccination, and severity of acute disease. Results Results indicate the predominant study’s focus on low-income and highly vulnerable people, with an elevated prevalence of comorbidities before LC. In the study population of 11,328 persons, 71.3% (95%CI 66.3; 76.2) reported frequently experiencing at least one persistent symptom, and 39.3% (95%CI 34.2; 44.4) self-reported having LC. The most frequent symptoms were fatigue, post-exertional malaise, joint pain, sleep disturbance, and cognitive impairment, and symptoms were consistently more likely to occur among women. Age was non-linearly related to LC, and comorbidities before COVID-19 hospitalization were positively associated with LC symptoms. Conclusions Evidence is provided for the LC burden among COVID-19 hospitalized patients even 24 months post-discharge. LC accessible and appropriate healthcare is fundamental.

Disinfectant tolerance in bacteria may be related to exposure to subinhibitory concentrations of disinfectants, which may activate efflux pumps capable of expelling antimicrobial compounds. The aim of this study was to evaluate the impact of disinfection on the presence of efflux pump genes and the resistance profile of Escherichia coli from commercial laying farms employing different disinfection protocols. The emrE, qacE, qacEΔ1, qacH, sugE(c), ydgE, ydgF, and class 1 integron (intl1) genes were investigated using PCR. Susceptibility to 17 antibiotics was assessed, including β-lactams, fluoroquinolones, aminoglycosides, and tetracyclines. Disinfectant exposure was significantly associated with higher frequencies of qacE and qacH, and a reduced frequency of ydgF. Moreover, resistance to ampicillin, trimethoprim–sulfamethoxazole, and doxycycline was significantly more frequent in E. coli isolated from chickens exposed to disinfectants. These findings indicate that disinfectant use can select for E. coli carrying efflux pump genes and resistance genes, favoring the survival and dissemination of tolerant and resistant strains in poultry production. Continuous monitoring and the development of disinfection strategies that minimize selective pressures are crucial for limiting the spread of antimicrobial resistance at the animal–human–environment interface.

IntroductionLong COVID (LC), an often-debilitating infection-associated chronic condition (IACC), affects millions of people globally. Globally, LC patients struggle to access timely, appropriate care, often experiencing disbelief, misunderstandings or being diverted from healthcare. Few studies have examined health system factors influencing LC healthcare access, especially in the Global South. Drawing on the concept of candidacy, we examine health system factors influencing access to LC care in Brazil’s public healthcare system (Sistema Único de Saúde, SUS) and theorise implications for equitable access to public healthcare for IACCs globally.MethodsWe conducted a patient-engaged, qualitative study in the city of Rio de Janeiro. 29 individual semi-structured interviews were conducted with SUS professionals from administrative leaders to multidisciplinary primary and specialist care staff (November 2022 to July 2023). Verbatim transcripts were analysed using a pragmatic thematic analysis.ResultsLC patients’ candidacy for care is invisibilised within SUS through multiple, interacting processes. Interplay of an over-burdened health system, prioritisation of resources in response to (flawed) evidence of demand, misalignment of LC patient capacities and demands of navigating fragmented services, complex referral processes, professionals’ lack of LC knowledge and disregard of the severity and morbidity of a chronic condition amid acute demands, led to the under-recognition of LC by healthcare professionals. Professionals’ under-recognition perpetuates administrators’ de-prioritisiation of resources, policies and training necessary to ensure access to appropriate care, creating a cycle of invisibilisation.ConclusionUrgent action to disrupt a cycle of invisibilisation is essential to mitigate patients’ suffering and intensification of inequalities. Disrupting this pernicious cycle requires more than narrow clinical education efforts. Improved surveillance, education, patient involvement, attention to moral injury and building on existing multidisciplinary strengths may enhance access to LC care. Doing so offers wider benefits beyond patients with LC. We call for a paradigm shift in clinical approaches to IACCs.

Background: Edwardsiella tarda infections are frequent causes of severe outbreaks in the fish farming industry besides representing possible zoonotic risks. However, naturally occurring outbreaks that affect various species besides fishes are seldom described. Aim: To report an outbreak of acute mortality caused by E. tarda affecting multiple species that inhabited a natural pond in the state of São Paulo, Brazil. Materials and methods: Three adult tilapias, three Mallard ducks and one Snow egret were necropsied and subjected to further microbiological tests. Gross and microscopic lesions were documented. The antibiotic susceptibility and phylogenetic similarities among fish and avian strains were also determined. The E. tarda species was confirmed through MALDI-TOF, partial sodB sequencing and phylogenetic analysis. Results: Macroscopical findings between the three species included intestinal dilatation, mucosal hyperaemia and mucous to liquid contents. Common histopathology findings included acute enteritis, increased number of intraepithelial lymphocytes with bacteria adhered to the intestinal epithelium and lymphoid depletion in the spleen. E. tarda was isolated from several organs from all affected species. The phylogeny employing amplified fragment length polymorphism (AFLP) of eleven strains revealed high similarity (>90%) among the isolates regardless of the affected species or sampled organs. Ten isolates of E. tarda showed susceptibility to all tested antibiotics. Conclusions: E. tarda was identified as the cause of death of the species examined. Further studies would be necessary to determine the virulence of these strains and the possible risks regarding public health.

Verjuice, a green grape juice traditionally produced from grapes obtained through thinning, represents a sustainable alternative for the utilization of viticulture by-products. No standardized methods of production are utilized to make verjuice, highlighting the need for further research. This study evaluated three extraction methods—pressing extraction (PE), steam extraction (SE), and centrifuge juicer extraction (CJE)—to produce verjuice from three Vitis labrusca varietals (Bordô, Concord, and White Niágara). Physicochemical parameters, volatile compounds (VOC), total polyphenol content, antioxidant and anti-hypertensive activities were analyzed. Extraction method and grape varietal influenced physicochemical composition, antioxidant capacity, and VOC. The SE method resulted in higher yields but lower polyphenolic content, while the CJE was more efficient in extracting phenolic compounds and preserving antioxidant properties. Higher concentrations of malic acid were observed in verjuice extracted by PE and CJE methods from Bordô and Concord grapes, while higher tartaric acid content was found in Bordô and Niágara grapes extracted by CJE. Within grapes, verjuices presented wider volatile profile than those described in the literature, and CJE and PE methods yielded higher amounts of VOC. Thus, V. labrusca presents great potential to produce verjuices and CJE shows to be an efficient alternative to the pressing method.

The objective of this study was to evaluate the effects of different combinations of monensin and narasin on finishing cattle. In Exp. 1, 40 rumen-cannulated Nellore steers [initial body weight (BW) = 231 ± 3.64 kg] were blocked by initial BW and assigned to one of the five treatments as follows: Control (CON): no feed additive in the basal diet during the entire feeding period; Sodium monensin (MM) at 25 mg/kg dry matter (DM) during the entire feeding period [adaptation (days 1–21) and finishing (days 22–42) periods]; Narasin (NN) at 13 mg/kg DM during the entire feeding period (adaptation and finishing periods); Sodium monensin at 25 mg/kg DM during the adaptation period and narasin at 13 mg/kg DM during the finishing period (MN); and narasin at 13 mg/kg DM during the adaptation period and sodium monensin at 25 mg/kg DM during the finishing period (NM). Steers fed MM had lower dry matter intake (DMI) during the adaptation period compared to NM ( P = 0.02) but not compared to CON, MM, MN, or NN ( P ≥ 0.12). No differences in DMI were observed among the treatments during the finishing ( P = 0.45) or the total feeding period ( P = 0.15). Treatments did not affect the nutrient intake ( P ≥ 0.51) or the total apparent digestibility of nutrients ( P ≥ 0.22). In Exp. 2, 120 Nellore bulls (initial BW = 425 ± 5.4 kg) were used to evaluate the effects of the same treatments of Exp. 1 on growth performance and carcass characteristics of finishing feedlot cattle. Steers fed NM had greater DMI during the adaptation period compared to CON, MM, and MN ( P ≤ 0.03), but no differences were observed between NM and NN ( P = 0.66) or between CON, MM, and NN ( P ≥ 0.11). No other differences between treatments were observed ( P ≥ 12). Feeding narasin at 13 mg/kg DM during the adaptation period increases the DMI compared to monensin at 25 mg/kg DM, but the feed additives evaluated herein did not affect the total tract apparent digestibility of nutrients, growth performance, or carcass characteristics of finishing cattle.