Explore the vast range of titles available.

Background: Pediatric patients infected with coronavirus disease 2019 (COVID-19) have unique clinical characteristics. Tumor necrosis factor (TNF) is a proinflammatory cytokine that greatly contributes to tumor pathogenesis.Purpose: To describe the presenting characteristics of COVID-19 infection among pediatric patients, and investigate the possible role of the TNF-α signaling pathway.Methods: This prospective case-control study included 50 Egyptian pediatric patients with COVID-19 and 50 healthy controls. Clinical, laboratory, and radiological assessments were performed. Serum TNF-alpha (TNF-α), TNF-α-converting enzyme (TACE), and angiotensin-converting enzyme 2 (ACE2) were measured using enzyme-linked immunosorbent assay. ACE (I/D) (rs4646994), ACE2 rs2285666, and TNF-α-308G/A single nucleotide polymorphisms (SNPs) were performed using conventional polymerase chain reaction techniques with or without restriction fragment length polymorphism.Results: The median age was 1 year (interquartile range [IQR], 0.31–2.50 years) in the case group and 1.45 years (IQR, 1.00–3.00) in the control group. The main presenting symptoms were fever (92%), dry cough (74%), and dyspnea (72%). The lymphocytic count was normal in 14 patients (28%), decreased in 16 patients (32%), and increased in 20 patients (40%) of the case group. Positive chest computed tomography finding of COVID-19 infection were demonstrated among 40% of patients using COVID-19 Reporting and Data System categories (ground-glass opacity with or without consolidations in the lungs). There were significant increased serum TACE and TNF-α with decreased ACE2 levels among cases versus controls (P< 0.001). The GG genotype and G allele of the TNF-α-308G/A SNP were significantly higher in patients than in controls (P<0.05 for both), with insignificant differences in genotype and allelic frequencies in the ACE (I/D) (rs4646994) and ACE2 rs2285666 SNPs.Conclusion: The TNF signaling pathway was significantly activated in pediatric COVID-19 infection. Only the TNF-α-308G/A SNP was significantly associated with pediatric COVID-19 infection.

COVID-19 ranks as one of the major pandemics in recent history, with healthcare workers disproportionately burdened by the disease. Vaccination emerged as the most effective measure to curb the spread and reduce COVID-19 morbidity and mortality. However, vaccine hesitancy presents a challenge to achieving optimal vaccination coverage in Nigeria. This study assessed the level of COVID-19-related stress and anxiety as well as factors associated with vaccine hesitancy among healthcare workers. A descriptive, cross-sectional study was conducted among 849 health workers of a tertiary hospital. Vaccine hesitancy, COVID-19 related stress and anxiety were assessed using the Vaccine Hesitancy Scale (VHS) and SAVE-6 scale respectively. Also, the WHO-5 index was used to assess the perceived mental wellbeing among study participants. Data analysis was conducted using SPSS 25 at univariate, bivariate and multivariate levels. There were slightly more males (479; 56.4%) than females and about four-fifth (674; 79.4%) of respondents were married. About one-quarter of health workers were vaccine hesitant, 236 (27.8%) while 96 (11.3%) had high levels of stress and anxiety. Also, 38 (4.5%) of respondents had poor mental wellbeing. Females when compared to males, had significantly higher odds (OR 1.50; 95% CI 1.10–2.10; p  = 0.023) of having vaccine hesitancy while those who were married compared to their single counterparts had significantly lesser odds (OR 0.60; 95% CI 0.36–0.94; p  = 0.026). However, there was no significant association between COVID-19 related anxiety and vaccine hesitancy. COVID-19 vaccine hesitancy exists even among health professionals. This study highlights that gender and marital status significantly influence vaccine hesitancy among healthcare workers. Healthcare workers need to receive vaccines to protect themselves and others. Given their role in educating patients and community members about vaccination against infectious diseases like COVID-19, targeted interventions are needed to address hesitancy and optimize vaccine acceptance among healthcare professionals.

Studies on the severity in multisystem inflammatory syndrome in children (MIS-C) show heterogeneous results and may not reflect a global perspective. This systematic review aims to estimate the frequency of in-hospital unfavorable outcomes in patients with MIS-C over the 3 years since the onset of the SARS-CoV-2 pandemic. A systematic search was conducted in Medline, Scopus, Embase, Cochrane, Web of Science, Scielo, and preprint repositories until December 15, 2022. Study selection and data extraction were evaluated independently. The primary outcomes were intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), and death. Additionally, we evaluated cardiovascular-related outcomes. We performed a random-effects model meta-analysis and assessed the certainty of the evidence. Fifty-seven studies ( n  = 13 254) were included. The frequency of ICU admission was 44.7% (95% CI 38.8–50.7), 11.9% for IMV (95% CI 9.6–14.4), and 2.0% for death (95% CI 1.3–3.0). The requirement of vasoactive/inotropic drugs was 40.1% (95% CI 35.9–44.4), 7.9% for coronary aneurysm (95% CI 4.1–12.7), 30.7% for decreased left ventricle ejection fraction (LVEF) (95% CI 26.3–35.4), and 29.7% for myocarditis (95% CI 18.4–42.4). We assess the included evidence as being of very low certainty. Finally, excess COVID-19 mortality by country and the diagnostic criteria for MIS-C (CDC compared to WHO) were associated with a higher frequency of ICU admissions. The year of study conduction (2022 compared to 2020) was associated with a lower frequency of IMV. Conclusion : The frequency of in-hospital unfavorable outcomes in patients with MIS-C was high. Well-designed studies are needed to explore other heterogeneity sources. Protocol registration : CRD42021284878. What is Known: • Multisystem inflammatory syndrome in children (MIS-C) is a serious post-infectious condition linked to SARS-CoV-2. Studies on the severity of MIS-C show heterogeneous results. These findings may not be representative of the reality in other regions, making it challenging to draw generalizable conclusions. What is New: • Over the 3 years since the onset of the SARS-CoV-2 pandemic, our systematic review has shown that the frequency of in-hospital unfavorable outcomes in patients with MIS-C is high, with a very low certainty of the evidence. Our results reflect the reality from a global perspective, across different countries with varying income levels. • The main sources of heterogeneity in the frequency of severe outcomes could be explained by the excess mortality due to COVID-19 in each country, the type of diagnostic criteria for MIS-C, and the year the study was conducted.

For children the consequences of the COVID-19 public health measures may have long-term effects into adulthood. By exploring children’s reactions more broadly, we are better placed to understanding the breadth of implications of home school and social isolation under COVID-19. The present study explored how COVID-19 related variables, namely, home school experience, child perceived family stress and instability, screen time use, missing friends and worry about virus infection are associated with children’s emotional, somatic/cognitive and worry reactions, respectively. A total of 442 children (M = 11.43 years, SD = 2.59) from the longitudinal FamilieForSK-study participated and a series of hierarchical linear regression models were applied controlling for background variables including children’s psychological vulnerability. Results showed significant associations between all COVID-19 related predictors, except screen time use, and the three outcomes. Family stress and instability had the strongest effects with standardised betas ranging from .356 to .555 and collectively, predictors explained between 20.7 and 44.1% of variance in outcomes. Furthermore, several associations were moderated by age and older children were more negatively impacted (i.e., higher level of reported reactions). The present study provides more conclusive evidence of the effects of home school and social isolation under COVID-19 on children. It also exemplifies the importance of focusing on children’s reactions more broadly, as there was evidence that children on average had fewer emotional reactions compared to before the pandemic.

Background and objectives Highly effective vaccines against severe acute respiratory syndrome virus 2 have been developed and administered worldwide. However, protection from coronavirus disease 2019 is not absolute and an optimal vaccination regimen needs to be established. This study assessed the clinical efficacy of the coronavirus disease 2019 vaccine among dialysis patients receiving 3 or 4 doses of vaccine. Design, setting, participants, and measurements This retrospective study was conducted using the electronic database of Clalit Health Maintenance Organization in Israel. Chronic dialysis patients treated with either hemodialysis or peritoneal dialysis during the coronavirus disease 2019 pandemic were included. We compared clinical outcomes of patients who had received three or four doses of the severe acute respiratory syndrome virus 2 vaccine. Results This study included 1,030 patients on chronic dialysis, with a mean age of 68 ± 13 years. Among them, 502 patients had received 3 doses of the vaccine and 528 received 4 doses. Severe acute respiratory syndrome virus 2 infection rates, severe COVID-19 that resulted in hospitalizations, COVID-19–related mortality and all-cause mortality rates were lower among chronic dialysis patients who received a fourth dose of vaccine as compared to those who received only 3 doses (after controlling for age, sex and comorbidities). Despite lower mortality rates observed with the Omicron variant, the fourth dose was significantly associated with reduced COVID-19-related mortality (1.7% vs. 3.8%, p  = 0.04). Odds ratio for COVID-19-related mortality was 0.44 with 95% CI 0.2–0.98. Conclusions As seen in the general population and with previous vaccine boosters, the fourth dose of the BNT162b2 vaccine reduced rates of severe COVID-19-related hospitalization and mortality among chronic dialysis patients. Further studies are needed to establish the optimal regimens of vaccination for patients on chronic dialysis. Graphical abstract

Research has linked specific COVID-19-related stressors to the mental health burden, yet most previous studies have examined only a limited number of stressors and have paid little attention to their clinical significance. This study tested the hypothesis that individuals who reported greater COVID-19-related stressors would be more likely to have elevated levels of anxiety, posttraumatic stress symptoms, and serious psychological distress. Methods: An online survey was administered to a convenience sample from 18 June to 19 July 2020, in US states that were most affected by COVID-19 infections and deaths at the time. Individuals who were 18 or older and residents of five Northeast US states were eligible to participate (N = 1079). In preregistered analyses, we used logistic regression models to test the associations of COVID-19 stressors with symptoms on the Generalized Anxiety Disorder-7 (GAD-7), Impact of Event Scale-Revised, and K6, adjusting for sociodemographic covariates. Results: COVID-19-related stressors (i.e., essential worker status, worry about COVID-19 infection, knowing someone hospitalized by COVID-19, having children under 14 at home, loneliness, barriers to environmental rewards, food insecurity, loss of employment) were associated with meeting thresholds (i.e., positive screening) for anxiety, posttraumatic stress, and/or serious psychological distress. Loneliness and barriers to environmental rewards were associated with all mental health outcomes. Limitations: We used a non-probability sample and cannot assume temporal precedence of stressors with regard to development of mental health symptoms. Conclusions: These findings link specific stressors to the mental health burden of the COVID-19 pandemic.

Purpose The Co-HCW study is a prospective, longitudinal, single-center observational study that aims to assess the SARS-CoV-2 seroprevalence and infection status in staff members of Jena University Hospital (JUH) in Jena, Germany. Methods This follow-up study covers the observation period from 19th May 2020 to 22nd June 2021. At each of the three voluntary study visits, participants filled out a questionnaire regarding their SARS-CoV-2 exposure and provided serum samples to detect specific SARS-CoV-2 antibodies. Participants who were tested positive for antibodies against nucleocapsid and/or spike protein without previous vaccination and/or reported a positive SARS-CoV-2 PCR test were regarded to have been infected with SARS-CoV-2. Multivariable logistic regression modeling was applied to identify potential risk factors for infected compared to non-infected participants. Results Out of 660 participants that were included during the first study visit, 406 participants (61.5%) were eligible for the final analysis as their COVID-19 risk area (high-risk n  = 76; intermediate-risk n  = 198; low-risk n  = 132) did not change during the study. Forty-four participants [10.8%, 95% confidence interval (95%CI) 8.0–14.3%] had evidence of a current or past SARS-CoV-2 infection detected by serology ( n  = 40) and/or PCR ( n  = 28). No association between SARS-CoV-2 infection and the COVID-19 risk group according to working place was detected. However, exposure to a SARS-CoV-2 positive household member [adjusted OR (AOR) 4.46, 95% CI 2.06–9.65] or colleague (AOR 2.30, 95%CI 1.10–4.79) was found to significantly increase the risk of a SARS-CoV-2 infection. Conclusion Our results demonstrate that non-patient-related SARS-CoV-2 exposure posed the highest infection risk for hospital staff members of JUH.

Nasal spray treatments that inhibit the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) entry into nose and nasopharynx at early stages can be an appropriate approach to stop or delay the progression of the disease. We performed a prospective, randomized, double-blind, placebo-controlled, parallel-group, multicentric, phase II clinical trial comparing the rate of hospitalization due to COVID-19 infection between azelastine 0.1% nasal spray and placebo nasal spray treatment groups. The study furthermore assessed the reduction in virus load in SARS-CoV-2-infected subjects estimated via quantitative reverse transcriptase polymerase chain reaction (RT-PCR) using nasopharyngeal swabs in both groups during the treatment period. A total of 294 subjects with mild COVID-19 infection were screened and randomized in a 1:1 ratio. There was no incidence of COVID-19-related hospitalization in either treatment group. Mean virus load was significantly reduced in both groups during the 11 treatment days as compared with baseline viral load values. The reduction in virus load in the azelastine 0.1% nasal spray group was significantly higher than the reduction in the placebo group at day 11 (log10 5.93 vs. log10 5.85 copies/mL, respectively, p = 0.0041). A total of 39 (32.0%) subjects in the azelastine 0.1% treatment group and 40 (31.0%) subjects in the placebo group reported 48 and 51 adverse events, respectively. It is therefore concluded that azelastine 0.1% nasal spray is an efficacious, safe, and well-tolerated treatment of mild COVID-19 infection.

BackgroundThe COVID-19 pandemic has changed our interpersonal relationships drastically. However, few research studies have examined pandemic-induced stress and its impact on relationship quality. The current research aimed to examine COVID-19 related stress and anxiety in relation to relationship satisfaction, well-being (i.e., positive affect and life satisfaction), and interpersonal emotion regulation strategies (i.e., perspective-taking, enhancing positive affect, social modeling, and soothing), to understand the effects of pandemic-induced stress on both an individual and a relational well-being. The moderating effect of interpersonal emotion regulation strategies toward COVID-19 related stress was also examined.MethodsThe sample consisted of 877 married Turkish adults (Nfemale = 613, Mage = 35.00; Nmale = 264, Mage = 39.21). Data were analyzed with structural equation modeling, and moderation effects were tested.ResultsAs hypothesized, structural equation modeling revealed that greater COVID-19 related stress was associated with lower well-being, and that this relationship was mediated by relationship satisfaction. Findings indicated that IER strategy of increasing positive emotions was associated with greater relationship satisfaction and well-being. Unexpectedly, interpersonal emotion regulation strategies moderated neither the relationship between COVID-19 related stress and relationship satisfaction nor the relationship between COVID-19 stress and well-being.ConclusionsOur findings support the vulnerability-stress-adaptation framework and draw attention to the importance of examining the effects of COVID-19 stress and relationship satisfaction.

Workers, especially healthcare workers, are exposed to an increased risk for SARS-CoV-2 infection. However, less is known about the impact of rehabilitation on health outcomes associated with post-COVID. This longitudinal observational study examined the changes in physical and neuropsychological health and work ability after inpatient rehabilitation of 127 patients (97 females/30 males; age 21–69 years; Mean = 50.62) who acquired COVID-19 in the workplace. Post-COVID symptoms, functional status, physical performance, neuropsychological health, employment, and work ability were assessed before and after rehabilitation. Group differences relating to sex, professions, and acute COVID status were also analyzed. Except for fatigue, the prevalence of all post-COVID symptoms decreased after rehabilitation. Significant improvements in physical performance and neuropsychological health outcomes were determined. Moreover, healthcare workers showed a significantly greater reduction in depressive symptoms compared to non-healthcare workers. Nevertheless, participants reported poor work ability, and 72.5% of them were still unable to work after discharge from rehabilitation. As most participants were still suffering from the impact of COVID-19 at rehabilitation discharge, ongoing strategies in aftercare are necessary to improve their work ability. Further investigations of this study population at 6 and 12 months after rehabilitation should examine the further course of post-COVID regarding health and work ability status.