Diagnosing COVID-19 and treating its complications remains a challenge. This review reflects the perspective of some of the Dragon (IMI 2-call 21, #101005122) research consortium collaborators on the utility of bronchoalveolar lavage (BAL) in COVID-19. BAL has been proposed as a potentially useful diagnostic tool to increase COVID-19 diagnosis sensitivity. In both critically ill and non-critically ill COVID-19 patients, BAL has a relevant role in detecting other infections or in supporting alternative diagnosis, and can change management decisions in up to two-third of patients. BAL is used to guide steroid and immunosuppressive treatment and to narrow or discontinue antibiotic treatment reducing the use of unnecessary broad antibiotics. Moreover, cellular analysis and novel multi-omics techniques on BAL are of critical importance for the understanding of the microenvironment and interaction between epithelial cells and immunity revealing novel potential prognostic and therapeutic targets. The BAL technique has been described as safe for both patients and health care workers in more than a thousand procedures reported to date in the literature. Based on these preliminary studies, we recognize that BAL is a feasible procedure in COVID-19 known or suspected cases, useful to properly guide patient management and with great potential for research.

Mini Commentary on manuscript ID BJOG-22-0531.R1

Objective: the exact link between COVID-19 pandemic and different adverse outcomes of pregnancy remains unclear. Plus, large-scale research is lacking. In the present study, we aimed to compare the maternal and fetal health outcomes during the COVID-19 pandemic with the same last year duration in Iran. Design: Two retrospective cohorts (pre-COVID-19 and during COVID-19) were studied. The pre-COVID-19 cohort include pregnant women who had given birth between 1 January 2019 and 31 December 2019. The COVID-19 cohort, who had given birth between 1 January 2020 and 31 December 2020. The characteristics of pregnant women before COVID-19 and during COVID-19 pandemic were compared with Fisher’s exact test. Uni-variate and multivariate log-binomial regression models were used to determine the risk ratios of the impacts of the COVID-19 pandemic on adverse pregnancy outcomes. Results: among 128968 women showed that women who had given birth during the pandemic were more likely to be of young age, lower rates of alcohol consumption and smoking, lower weight gain, and higher rates of using synthetic milk for feeding neonates (P<0.05). Also, the risks of preterm labor were high (cOR 95% CI, 1.13 to 1.31; p<0.01) and the risk of caesarian were low (cOR 95% CI, 0.95 0.92 to 0.98; p<0.01) among pregnant women who gave birth during the COVID-19 pandemic compared with those who gave birth before the pandemic. Conclusions: In summary, we found that during the COVID-19 pandemic there were the higher risks of preterm labor and lower risk of caesarean among pregnant women.

Severe Acute Respiratory Coronavirus Syndrome 2 (SARS-CoV-2) is a new human coronavirus family discovered during the highly communicable respiratory disease outbreak in Wuhan, China, in 2019. Various COVID-19 vaccines are up to 95% effective against symptomatic infections caused by the COVID-19. Whether people with PD or PS have an increased risk of COVID-19 and are associated with a higher risk of death is still uncertain. In this study, we report eleven cases of PD patients who died whitin 24 hours after vaccination with the Sinopharm. All patients were over 79 years old (84.64 ± 5.08). All patients were SARS-CoV2 PCR negative and took their first dose of the Sinopharm. All patients had a duration of more than 5 years with PD. All patients presented to the hospital less than 12 hours after vaccination. All patients died less than 24 hours after vaccination. In this study, All the patients were elderly and hypertension and diabetes were seen in 11 (100%) and 7 (63.6%) patients which could reinforce the hypothesis that older patients with PD should be vaccinated more cautiously and these patients should be discussed the vaccine with their physician especially in patients who have other comorbidities. Because our report was a case series study, we only identified patients, and the causality could not be assumed or proven.

A document by Sara Zaidi, written on Authorea.

Background and Purpose: Dysregulation of adult hippocampal neurogenesis is linked to major depressive disorder (MDD), with more than 300 million people diagnosed and worsened by the COVID-19 pandemic. Accumulating evidence for Neuropeptide Y (NPY) and galanin (GAL) interaction was shown in various limbic system regions at molecular-,cellular- and behavioral-specific levels. The purpose of the current work was to evaluate the proliferating role of GALR2 and Y1R agonists interaction upon intranasal infusion in the ventral hippocampus. Experimental approach: We studied their hippocampal proliferating actions using the proliferating cell nuclear antigen (PCNA) and the expression of of the brain-derived neurothrophic factor (BDNF). Moreover, we studied the formation of Y1R-GALR2 heteroreceptor complexes and analyzed morphological changes on hippocampal neuronal cells. Finally, the functional outcome of the NPY and GAL interaction on the ventral hippocampus was evaluated in the forced swimming test. Key Results: We demonstrated that the intranasal infusion of GALR2 and the Y1R agonists promotes cell proliferation in the DG of the ventral hippocampus and the induction of the neurotrophic factor BDNF. These effects were mediated by the increased formation of Y1R-GALR2 heteroreceptor complexes, which may mediate the neurites outgrowth observed on neuronal hippocampal cells. Importantly, BDNF action was found necessary for the antidepressant-like effects after GALR2 and the Y1R agonists intranasal administration. Conclusions & Implications: Our data may suggest the translational development of new heterobivalent agonist pharmacophores acting on Y1R–GALR2 heterocomplexes in the ventral hippocampus for the novel therapy of mayor depression disorder or depressive-affecting diseases.

COVID-19 is a worldwide pandemic disease that caused respiratory symptoms and severe complications. The mRNA vaccine were developed to prevent COVID-19 disease. Here we reported a case of a subepidermal blistering eruption as a cutaneous reaction after mRNA boosted vaccination in a post-covid patient.

The Nairovirus causing the Crimean Congo Hemorrhagic Fever (CCHF) is transferred mainly via ticks and farm animals. Its incidence is spread over several countries broadly categorized into continents, including Europe, Asia, and Africa. This editorial is shedding light on this concerning pathogen and suggesting several strategies to tackle it.

One of the serious side effects of COVID-19 vaccines is vaccine-induced immune thrombotic thrombocytopenia (VITT). A young man presented with pulmonary thromboembolism 7 days after receiving inactivated COVID-19 vaccine BIBP developed by Sinopharm/China. Close surveillance of possible adverse reactions a crucial step to encourage population to participate in vaccine campaign.

A 48-year-old woman was diagnosed with right-sided Grade 2 invasive breast carcinoma. Prior to initiation of chemotherapy, transthoracic echocardiogram (TTE) demonstrated normal systolic function with left ventricular ejection fraction (LVEF) 64% and global longitudinal strain (GLS) 21%. Following adjuvant chemotherapy with four cycles of anthracycline, twelve cycles of Paclitaxel, and two cycles of Trastuzamab chemotherapies, TTE demonstrated reduction in LVEF to 56% and GLS of -18% (14% relative reduction compared to baseline). Further investigation revealed recent symptomatic COVID-19 infection coinciding with functional impairment and decision was made to continue Trastuzumab therapy without cardioprotective agents. Subsequent TTE demonstrated improved systolic function, indicating the importance of taking history of significant viral infections during chemotherapy standard of care.

Key Points:  COVID-19 often cause prolonged olfactory dysfunction.  This study evaluated the relative burden of the COVID-19-related disease in a single-centered cohort of POD patients.  COVID-19-related POD was diagnosed serologically.  In the COVID-19 era, the local burden of POD increased two-fold.  It is important to use pleiotropic approach and robust measures, when we assess OD.

The Covid-19 lockdown reduced drastically human presence outdoors, providing an uncontrolled experiment for disentangling direct and indirect effects of human presence on animal fearfulness. We measured 18,494 flight initiation distances (FIDs, the distance at which individual animals fly away when approached by a human) from 1,333 populations of 202 bird species taken in four European cities both before, during and after the lockdown. Differential responses to lockdown among urban and rural habitats and between signing and non-singing birds showed that lockdown relaxed direct disturbance effects on birds in rural habitats, but increased indirect fear effects mediated by predator release (mainly feral cats) in cities.

Introduction: E-cigarette, or vaping, product use-associated lung injury (EVALI) results from inhaling the aerosol of e-cigarettes and has similar clinical features to coronavirus disease 2019 (COVID-19). EVALI case counts since the declaration of the COVID-19 pandemic is unknown. Methods: A retrospective electronic health record chart review of adolescents hospitalized at one institution with EVALI was conducted. Clinical characteristics and hospital course of patients hospitalized during the pandemic were compared to those pre-pandemic. Results: The clinical presentation of adolescents hospitalized prior-to (n=19) and during the COVID-19 pandemic (n=22) were similar with respect to constitutional, respiratory, and gastrointestinal symptoms. All patients hospitalized during the pandemic were tested for COVID-19 at least once. Only one patient had a positive SARS-CoV-2 RT-PCR test result. 31 out of 39 patients treated with corticosteroids had clinical improvement within 24 hours (79%). Patients hospitalized during the pandemic had a shorter median length of stay (5 vs 7 days, p<0.01), and were less often discharged with home oxygen (1 vs 6 patients, p=0.04). Pulmonary function tests improved pre-to post-corticosteroid treatment and post-corticosteroid to follow-up. Conclusions: Eliciting a history of vaping in adolescents presenting with constitutional, respiratory, and gastrointestinal symptoms is important to identify EVALI cases, which have continued throughout the COVID-19 pandemic. A shorter length of stay with less need for mechanical ventilation and home oxygen in adolescents hospitalized during the pandemic may reflect increased familiarity with EVALI characteristics. Corticosteroids led to clinical and pulmonary function improvement.

A document by Frank Annie, written on Authorea.

Tens of millions of our own kind are killed by diseases in spite of the laudable effort of our healthcare teams every single year that the problem of immunity remains unsolved. But this problem is not longstanding because of the complexity of the nature of immunity but rather because we have been trying to obtain the knowledge we require to solve problems from theories that are logically deduced from observations when such knowledge can only be obtained from theories that are obtained with a method that requires reality to be illustrated and deductions to be made only for the purpose of knowing whether or not we have obtained the knowledge we seek from the results of our illustrations through the agreement or disagreement between facts and the consequences we have deduced from such results. The most influential among the theories of immunity is that which Ilya Mechnikov logically deduced from inflammatory phenomena in which phagocytosing cells that envelope and store foreign entities are brought to sites of cell death even in the absence of pathogens. This theory of immunity aimed to find proof for the logical deduction in which Pasteur and co-workers proposed the mechanism by which

Logical conclusions from observations have been unable to verifiably account for the nature of long COVID or the nature of its solution. In this paper, a verifiable hypothesis emerges from the reality we have illustrated with a superior method of obtaining knowledge which makes logical deductions only to obtain consequences, those predictions which must agree perfectly with observations if indeed our hypotheses are the knowledge we require to solve longstanding problems. The results of the illustrated reality in the previous investigation 1 lead to a very interesting and important consequence. And with the goal of eliminating difficulties such as those presented by long COVID, we shall deduce this consequence here.

Objective: To evaluate the behavior of the viruses responsible for acute respiratory infections before (2016-2019) and after (2020-2021) the start of the circulation of the SARS-CoV-2 virus in pediatric patients treated at a reference center from Barranquilla, Colombia. Materials and methods: An observational descriptive study was carried out, data were obtained reviewing the influenza-like illness and severe acute respiratory infection database in the pediatric population of the sentinel surveillance reference center in the district of Barranquilla during the years 2016 - 2021, applying inclusion and exclusion criteria. Results: During 2016-2019, the average age of individuals was 1.3 (±1.7) years, during 2021 it was 2.3 (±3.5) years. The distribution by sex was similar, predominantly male. August and February were the months with the highest record of symptoms for 2016-2019 and 2021, respectively, the most frequent being cough, fever, shortness of breath, and diarrhea. By 2021 there was higher use of antibiotics and antivirals reported than in 2016-2019. Most patients tested negative for viral detection. When comparing the percentage of viruses detected by age group and years of detection, positivity was lower in 2021 by every age group, and respiratory Syncytial Virus (RSV) was the most frequently detected. Conclusions: There was less virus positivity in viral detection tests in the pediatric population during 2021. RSV persists as the main etiology affecting this population, especially infants. The use of antibiotic therapy in viral infections continues to be a problematic practice in their management. Sentinel surveillance can be strengthened throughout the country.

Background: By December 2021, administration of the third dose of COVID-19 vaccinations coincided with the spread of the Omicron variant in Europe. Questions had been raised on protection against infection conferred by previous vaccination and/or infection. Method: Our study population (n = 252,433) included all those in the COVID-19 vaccination registry in Malta who were vaccinated with only 2 doses equivalent by 15th December 2021, and not vaccinated with an additional dose by 8th March 2022, and alive by 8th March 2022. Data were then matched with the national testing database (all RT-PCR/Rapid Diagnostic Tests - RDT tests) until 8th March. We collected vaccination status, vaccine brand, vaccination date, infection history, and age. Using logistic regression, we examined different combinations of vaccine dose, prior infection status and time, and the odds of infection during the Omicron period (December 15th, 2021 onwards). Results: Results found that participants infected with Sars-Cov-2 prior to the Omicron wave had a significantly lower odds of being infected with the Omicron variant. Additionally, the more recent the infection and the more recent the vaccination, the lower the odds of infection. Receiving a third dose within 20 weeks of the start of the Omicron wave in Malta offered similar odds of infection as receiving a second dose within the same period. Conclusion: Time since vaccination is a strong determinant factor against infection, as was previous infection status and the number of doses taken. This finding reinforces the importance of future booster dose provision especially to vulnerable populations.

Background and Aims: Worldwide, the incidence of COVID-19 is lower in children than in adults and symptoms are less severe. So far, few studies from Latin America have been published on the behavior of COVID-19 in children with cancer. Purpose: To characterize the epidemiology, clinical course, morbidity, and mortality in children with cancer and COVID-19. Methods: All patients registered in the Argentine National Pediatric Cancer Registry (ROHA) with diagnosis of SARS-CoV-2 between December 4, 2020, and May 3, 2022 were included. Variables analyzed were: sex, age at COVID-19 diagnosis, clinical presentation at diagnosis, symptom severity, tumor type, intensive care requirement, specific treatment for COVID-19, vital status, and cause of death. Mortality was analyzed comparing the three main waves. Results: Overall, 888 children with cancer and COVID-19 infection were registered (484 females); 437 (49.2%) had leukemia, followed by central nervous system tumors (CNS-T) 120 (13.5%). Of the children, 57.2% (n=508) were symptomatic; 75% were febrile, and 37% (n=210) had neutropenia; 17.1% (n=152) were diagnosed within one month of cancer diagnosis. A total of 154 children had severe or critical symptoms (17%). In this study, 112 deaths were reported, 105 (94%) due to disease progression, sepsis, comorbidities, or treatment complications. Seven patients (0.8%) died from COVID-19, all diagnosed with leukemia/lymphoma. No association of deaths was found between the three waves analyzed. Conclusions: Based on the ROHA data, we may conclude that in pediatric cancer patients, contrary to what was initially expected, morbidity and mortality due to COVID-19 were not increased.

Background: As elective surgical services recover from the COVID-19 pandemic a movement towards day-case surgery may reduce waiting lists. However, evidence is needed to show that day-case surgery is safe for many ENT operations including endoscopic sinus surgery (ESS). We aimed to investigate the safety of ESS in England. Methods: This was an observational, secondary analysis of administrative data. Participants were all patients in England undergoing elective ESS procedure aged ≥ 17 years during for the five years from 1st April 2014 to 31st March 2019. The exposure variable was day-case or overnight stay. The primary outcome was emergency readmission within 30 days post-discharge. Results: Data were available for 49,223 patients operated on across 129 NHS hospital trusts. In trusts operating on more than 50 patients in the study period, rates of day-case surgery varied from 100% to 20.6%. Rates of day-case surgery increased from 64.0% in 2014/15 to 78.7% in 2018/19. Day-case patients had lower rates of 30-day emergency readmission (odds ratio 0.71, 95% confidence interval 0.62 to 0.81). For secondary outcomes measures, there was no evidence of poorer outcomes for day-case patients. Outcomes for patients operated on in trusts with ≥80% day-case rates compared to patients operated on in trusts with <50% rates of day-case surgery were similar. Conclusions: ESS can safely be performed as day-case surgery at current rates. There is a potential to increase rates of day-case ESS in England, especially in departments that currently have low rates of day-case ESS.

Background: Cardiac injury has been described in children with both acute COVID-19 and the multisystem inflammatory syndrome in children (MIS-C). Strain has been shown to be a sensitive measure of systolic function and can be used for detecting subclinical left ventricular (LV) dysfunction. We sought to describe strain findings in both groups on initial presentation and outpatient follow up. Methods: A retrospective study analyzing echocardiograms of all patients presenting with acute COVID-19 infection and MIS-C at our institution between March 2020 and December 2020 was performed. TOMTEC software was used for strain analysis in both study groups (COVID-19 and MIS-C) and age matched healthy controls. Regional strain was obtained and comparison amongst groups was performed using the Mann-Whitney U test. Strain was compared against LV ejection fraction (EF) as measured by 5/6 area length method. Results: 45 patients (34 MIS-C and 11 COVID-19) met inclusion criteria. There was a statistically significant decrease in LV longitudinal strain (p <0.001), LV circumferential strain (p <0.001) and left atrial strain (p = 0.014) in the MIS-C group when compared to the control group. There was a statistically significant decrease in LV longitudinal strain (p = 0.028) in the acute COVID-19 group. All patients with abnormal LVEF had abnormal strain. However 14 patients (41%) in the MIS-C group and 3 (27%) in the acute COVID-19 group had preserved LVEF but abnormal strain. Abnormal strain persisted in one-third of patients in the MIS-C and acute COVID-19 groups on outpatient follow up. Conclusion: Patients with MIS-C and acute COVID-19 can develop myocardial dysfunction as seen by abnormal strain. Strain may provide an additional tool in detecting subtle myocardial dysfunction. It can be routinely employed at diagnosis and at follow up evaluation of these patients.

Objectives: To understand the epidemiological and clinical characteristics of pediatric SARS-CoV-2 infection during the early stage of Omicron variant outbreak in Shanghai. Study designs: This study included local COVID-19 cases<18 years in Shanghai referred to the exclusively designated hospital by the end of March 2022 since emergence of Omicron epidemic. Clinical data, epidemiological exposure and COVID-19 vaccination status were collected. Relative risks (RR) were calculated to assess the effect of vaccination on symptomatic infection and febrile disease. Results: A total of 376 pediatric cases of COVID-19 (median age:6.0±4.2 years) were referred to the designated hospital during the period of March 7-31, including 257 (68.4%) symptomatic cases and 119 (31.6%) asymptomatic cases. Of the 307 (81.6%) children ≥3 years eligible for COVID-19 vaccination, 110 (40.4%) received 2-dose vaccines and 16 (4.0%) received 1-dose vaccine. The median interval between 2-dose vaccination and infection was 3.5 (IQR: 3, 4.5) months (16 days-7 months). Two-dose COVID-19 vaccination reduced the risks of symptomatic infection and febrile disease by 35%(RR 0.65, 95% CI: 0.53-0.79) and 33% (RR 0.64, 95% CI: 0.51-0.81). Two hundred and sixteen (83.4%) symptomatic cases had fever (mean duration:1.7±1.0.8 days), 104 (40.2%) had cough, 16.4% had transient leukopenia; 307 (81.6%) had an epidemiological exposure in household (69.1%) , school (21.8%) and residential area (8.8%). Conclusion: The surge of pediatric COVID-19 cases and multiple transmission model reflect wide dissemination of Omicron variant in the community. Asymptomatic infection is common among Omicron-infected children. COVID-19 vaccination can offer some protection against symptomatic infection and febrile dise

Purpose: Left ventricular diastolic dysfunction (LVDD) is associated with poor outcomes in intensive care unit (ICU). Nonetheless, precise reporting of LVDD in COVID-19 patients is currently lacking and assessment could be challenging. Methods: We performed an echocardiography study in COVID-19 patients admitted to ICU with the aim to describe the feasibility of full or simplified LVDD assessment and its incidence. We also evaluated the association of LVDD or of single echocardiographic parameters with hospital mortality. Results: Between 06.10.2020 and 18.02.2021, full diastolic assessment was feasible in 74% (n=26/35) of patients receiving full echocardiogram study. LVDD incidence was 46% (n=12/26), whilst the assessment produced different results (incidence 81%, n=21/26). Nine patients were hospital-survivors (39%); incidence of LVDD (full assessment) was not different between survivors (n=2/9, 22%) and non-survivors (n=10/17, 59%; p=0.11). Also, the E/e’ ratio lateral was lower in survivors (7.4 [3.6] vs non-survivors 10.5 [6.3], p=0.03). We also found that s’ wave was higher in survivors (average, p=0.01). Conclusion: In a small single-center study, assessment of LVDD according to latest guidelines was feasible in three quarter of COVID-19 patients. Non-survivors showed a trend towards greater LVDD incidence; moreover, they had significantly worse s’ values (all) and higher E/e’ ratio (lateral).

Aim. To assess the relationship between a fact of being prescribed fluvoxamine around the time of COVID-19 diagnosis and subsequent hospitalizations and mortality in COVID-19 outpatients. Methods. Using administrative data, we identified adult COVID-19 outpatients diagnosed up to August 15, 2021 in Croatia. Subjects prescribed fluvoxamine around the time of COVID-19 diagnosis (Group A), their peers suffering similar psychiatric difficulties but not prescribed with fluvoxamine (Group B) and those free of psychiatric difficulties/treatments (Group C) were mutually exactly matched on a range of pre-COVID covariates. We determined relative risks of COVID-19-related hospitalization, 30-day all-cause hospitaliziation and of COVID-19-related mortality. Results. Out of 416030 outpatients, 1016 were Group A subjects, 749 of whom were matched to 31336/95984 Group B subjects, while 866 were matched to 22792/275804 Group C subjects. Group B and C patients were matched 82323 to 268778. Matched A vs. B relative risks (95%CI/CrI), frequentist and Bayes with skeptical, otpimistic and pesimistic priors, were: COVID-related hospitalization 1.73 (0.56-3.33), 1.15 (0.55-2.11), 1.03 (0.56.1.96) and 1.43 (0.63-2.94), respectively; 30-day all-cause hospitalization 1.88 (0.76-4.67), 1.76 (1.39-2.25), 1.76 (1.39-2.24) and 1.86 (1.43-2.38), respectively; COVID-19 related mortality 0.73 (0.35-1.55), 0.93 (0.53-1.76), 0.79 (0.40-1.54) and 0.88 (0.37-2.11), respectively. Conslusion. COVID-19 outpatients prescribed fluvoxamine around the time of COVID-19 diagnosis were not at a reduced risk of subsequent hospitalizations and mortality compared to COVID-19 outpatients suffering similar psychiatric difficulties but not prescribed with fluvoxamine, or compared to COVID-19 outpatients free of psychiatric difficulties and related treatments