With technological breakthroughs, drone deliveries have become increasingly popular, especially during the COVID-19 pandemic. Driven by both economical benefit and efficiency, drone-truck combined deliveries are in demand. However, it is very challenging to handle the collaboration between trucks and drones. Existing methods for truck-only routing cannot be directly applied, since their solution representations and search operators cannot consider the drone-truck collaborations effectively. In this paper, we model the system as Traveling Salesman Problem with Drones (TSP-D), and propose a new memetic algorithm named MATSP-D for solving it. Specifically, we design a new drone-truck solution representation and develop new crossover and local search operators under the new representation, which can modify the drone services effectively. MATSP-D conducts exploration by crossover, and exploitation by a variable neighborhood search process. The experimental results show that the proposed MATSP-D significantly outperforms the state-of-the-art algorithms for most test instances, especially the large instances with more complex collaborations between the truck and drone. Further analysis verifies the effectiveness of the newly developed local search operators in searching for better drone-truck collaborations.

This study introduces Norma, a novel association-mining framework tailored for continuous spatial variables analysis. Norma introduces the unique Continuous Variable Threshold (CVT) pattern, aiming to identify a pair of thresholds within the value domain of two continuous variables, revealing strong associations within a specified geographic area. For example, it may unveil a strong association between COVID-19 infection rates above 2% and poverty rates above 15% in New Mexico. Norma associates pointwise functions with each variable-e.g., a function that returns poverty rates for each location in New Mexico. It employs a novel interestingness function, which measures agreement with respect to hotspots where variable pointwise functions exceed associated thresholds. Norma also employs a grid-based spatial hotspot-growing algorithm to discover high-interestingness regions and pairs of thresholds that generate interestingness surpassing a predefined threshold. Furthermore, the framework introduces measures for assessing variable relatedness based on CVT associations. A comparative case study against traditional correlation methods are presented using county-level COVID-19 infection rates and nineteen other socio-economic variables from the continuous United States, and demonstrate how Norma can be used to explore association among subset of values related to spatial continuous variables.

Background: The COVID-19 pandemic caused by the SARS-CoV-2 virus is still causing extensive sickness, death, and social and economic devastation worldwide. Effective prophylactic strategies such as personal protection measures, social distancing, and vaccination is critical in limiting disease transmission. However, more than two years after the emergence of COVID-19, the pandemic continues to have a global impact, with new variants and surges in cases and fatalities. Objectives: This study aimed to investigate the Pakistani public’s perception and knowledge regarding various aspects of COVID-19 after a period of two years of the pandemic. The study also aimed to investigate the association between education level and knowledge about COVID-19. Methods: An online cross-sectional survey was conducted using a convenience sample of 1100 individuals from different cities in Pakistan. The survey consisted of various sets of questions covering the aspects of the study objectives. Results: Most participants reported a solid understanding of COVID-19; however, there were some misconceptions and knowledge gaps concerning certain pandemic elements. The study also highlighted a link between education level and awareness of COVID-19, with a higher education level related to a better understanding of the pandemic and effective preventive strategies. Conclusion: This study provides valuable insight into the perception and education level of the Pakistani public regarding COVID-19. The findings highlight the need of continued public health efforts to promote and ensure access to effective prevention measures, particularly in vulnerable populations who may face barriers to obtaining protective equipment.

Infection with influenza A virus (IAV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses a significant risk to human life, health, and the global economy. Vaccination is one of the most effective strategies in the fight against infectious viruses. In this study, we, for the first time, have evaluated the immunogenicity and protective effect of an influenza/SARS-CoV-2 Omicron subunit combined vaccine adjuvanted with MF59 and administered to BALB/c mice. Results showed that the combined vaccine induced high levels of IgG, IgG 1, and IgG 2a antibodies, as well as influenza A H1N1/California/2009 virus-specific hemagglutination-inhibiting antibodies in BALB/c mice. Moreover, this subunit combined vaccine induced high titers of neutralization antibodies against SARS-CoV-2 Omicron BA.5 pseudovirus and effectively reduced the viral load of authentic SARS-CoV-2 Omicron BA.5.2 variant in the cell culture supernatants. These results suggested that this subunit combined vaccine achieved protective effect against both H1N1 A/California/07/2009 strain and SARS-CoV-2 Omicron BA.5.2 variant. It is therefore expected that this study will establish the scientific foundation for the next-step development of combined vaccines against other strains or variants of IAV and SARS-CoV-2.

Over the last two decades, lipid nanoparticles (LNPs) have evolved as an effective biocompatible and biodegradable RNA delivery platform in the field of nanomedicine, biotechnology and drug delivery, with the current successes as COVID-19 mRNA vaccines. Therefore, it is important to provide a general workflow of studying RNA-based LNP performance, which further offers useful guidance for researchers who want to work in the RNA-based LNP field. In this perspective, we first summarized the approaches for the preparation of LNPs, followed by the introduction of the key characterization parameters. Then, the in vitro evaluation of LNP performance including cell selection, cell viability, cellular association/uptake, endosomal escape and their efficacy was summarized. Finally, the in vivo assessment in the aspects of animal selection, administration, dosing and safety, and their therapeutic efficacy was discussed. We hope this perspective can offer valuable guidance to researchers who enter the field of RNA-based LNPs and help them understand the crucial parameters that RNA-based LNP demands.

Rhino-orbital-cerebral mucormycosis (ROCM) is a rare angioinvasive fungal infection known to be associated with high morbidity and over 50% mortality and has increased lately due to increasing predisposing immunocompromising comorbidities as well as COVID-19. In addition to the common acute disease progression, chronic less aggressive courses have been described less often. In this paper we report two cases – a 75-year-old woman with diabetes and a 39-year-old man with recurrent diabetic ketoacidosis. Both presented initially with acute sinonasal symptoms, were positive for SARS-COV-2 and later diagnosed with acute ROCM.  Both underwent mutilating surgical therapy as well as high administered dose Amphotericin B and long term continuous antifungal therapy. Patient 1 showed stable symptoms with radiographically increasing disease and died of urosepsis 5 months after first surgery. Patient 2 was first lost to follow-up after repatriation to his home country and 1 year later sent us a holiday picture of himself, having recovered from the disease.Key words:Rhino-orbital-cerebral mucormycosis, mucormycosis, Amphotericin-B, COVID-19, invasive fungal infection

Background and Aims: The long-term respiratory sequelae of COVID-19 infection in children remain poorly understood and may differ across countries. This study aims to investigate the respiratory sequelae, including residual respiratory symptoms and pulmonary function in Thai children. The secondary aim is to identify factors associated with the respiratory sequelae. Materials and Methods: This is an observational study involving 56 healthy children, aged between 7-18 years, who were diagnosed with COVID-19 infection from July 2021 to February 2023. Clinical data relating to COVID-19 infection and persistent symptoms after the infection were assessed after the infection up to six months. Spirometry was performed to assess pulmonary function. Results: Post COVID-19 symptoms were identified in 14 patients (25%), with fatigue, cough, and dyspnea being common symptoms (28-35%). A significant correlation was found between post COVID-19 symptoms and pneumonia (OR = 6.00, 95%CI [1.54,23.33], p=0.01). Abnormal pulmonary function was identified in 10 patients (17.8%) with obstructive impairment being the most common. However, there were no significant association between clinical factors and pulmonary function impairment. Conclusion: Prolonged respiratory symptoms and abnormal pulmonary function following COVID-19 infection are not uncommon in children. The post COVID-19 symptoms are possibly associated with COVID-19 pneumonia.

Introduction: COVID-19 pandemic led to significant reductions in influenza detection worldwide, making influenza trends challenging to monitor. The number of influenza cases decreased significantly in Japan, raising concerns about the potential risk of decreased immunity to influenza in the population. Our single-center study aimed to investigate influenza trends before and during the COVID-19 pandemic in Tokyo, Japan. Materials and Methods: This cross-sectional study included patients of all ages who visited Tokyo Shinagawa Hospital between April 1, 2018, and March 31, 2023. Influenza and COVID-19 tests were conducted using Quick Navi-Flu2 and polymerase chain reaction (PCR). We analyzed data from before and during the COVID-19 epidemic, based on patient background, hospitalization, and deaths, collected from medical records. Results: A total of 12,577 influenza tests were conducted, with approximately 100 tests consistently performed each month even in the influenza off-season. Throughout the observation period, 962 positive cases were identified. However, no cases were observed for 27 months between March 2020 and November 2022. Cases of influenza A were observed again in December 2022, and cases of influenza B were observed again in March 2023, similar to the influenza incidence reports from Tokyo. The positivity rate during the 2022–2023 winter season was lower than before the COVID-19 epidemic and decreased in elderly patients, with no hospitalizations or deaths observed. Conclusion: This single-center study provided actual trend data for influenza patients before and during COVID-19 outbreaks in Tokyo, which could offer insights into the potential impact and likelihood of influenza virus infection in Japan.

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the coronavirus disease 2019 (COVID-19), which is associated with cardiovascular problems and serious lung damage. COVID-19 patients with comorbid conditions are at a significantly elevated risk of increased morbidity and mortality. Angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine 2 (TMPRSS2) are the two key host contributing factors for the severity and pathogenesis of COVID-19. The principal SARS-CoV-2 entrance receptor, ACE2, is expressed equally in most organs and produces cardio-protective vasodilators by physically degrading angiotensin II, the main controller of the Renin-Angiotensin Aldosterone System. However, treatment for cardiovascular disease (CVD) commonly involves RAAS inhibitors, which may increase ACE2 expression. Objective: To summarize the pharmacological molecular discoveries into the processes of viral infection and its consequences for cardiovascular disease and to offer suggestions for the practical management and treatment of COVID-19-related cardiovascular injury. Methods: This review focuses on the important considerations related to the cardiovascular manifestations of COVID-19 and discusses the various mechanisms of COVID-19 that contribute to its molecular and pharmacological presentation of cardiovascular injury. Results: The host-pathogen relationship began with ACE2’s attachment to the S-protein and proceeded with TMPRSS2’s proteolytic cleavage of the viral spike (S)-protein and ACE2. Currently discovered protein-protein interactions explain the uniqueness of SARS-CoV-2 infection. Conclusion: COVID-19 is associated with cardiovascular problems and serious lung damage. ACE2 and TMPRSS2 are key host contributing factors for the severity and pathogenesis of COVID-19. The molecular discoveries into the processes of viral infection and its consequences for cardiovascular disease provide important considerations for the management and treatment of COVID-19-related cardiovascular injury.

Undergraduate program in Electrical and Computer Engineering (ECE) is a four years curriculum where students work on a number of software to complete their coursework. These tools are accessible to students in university where students spend several hours to complete their assignments, a process not doable under COVID-19 global lockdown. Hence, students either (i) access their university labs remotely via virtual private networks, or in the absence of remote access either (sadly) (ii) resort to using pirated software, or (regretfully) (iii) are deprived of hands-on knowledge of the course. In this (post) Covid-19 era, educators are required to adopt their teaching pedagogy to ensure maximum delivery of their course material. In an attempt to facilitate experimental learning, this humble effort provides a detailed survey of Linux-based tools coupled with their corresponding coursework within ECE with the hope that the content provided in this paper will be of some relief to students and teachers engaged in ECE education globally.

Background: The COVID‐19 pandemic have impacts on the prevalence of other [pathogen](javascript:;)s and people’s social lifestyle. This study aimed to compare the [pathogen](javascript:;), allergen and micronutrient characteristics of pediatric inpatients with pneumonia prior to and during the COVID-19 pandemic in a large tertiary hospital in Shanghai, China. Methods: Patients with pneumonia admitted to the Department of Pediatric Pulmonology of Xinhua Hospital between March-August 2019 and March-August 2020 were recruited. And clinical characteristics of the patients in 2019 were compared with those in 2020. Results: Hospitalizations for pneumonia decreased by 74% after the COVID-19 pandemic. For [pathogen](javascript:;)s, virus, mycoplasma pneumoniae (MP) and mixed infection rates were all much lower in 2020 than those in 2019 ( P < 0.01). Regarding allergens, compared with 2019, the positive rates of house dust mite, shrimp and crab were significantly higher in 2020 ( P < 0.01). And for micronutrients, the levels of vitamin B2, B6, C and 25-hydroxyvitamin D (25(OH)D) in 2020 were observed to be significantly lower than those in 2019 ( P < 0.05). For all the study participants, longer hospital stay (OR = 1.521, P = 0.000), milk allergy (OR = 6.552, P = 0.033) and [calcium](javascript:;) (Ca) insufficiency (OR = 12.048, P = 0.019) were identified as high-risk factors for severe pneumonia by multivariate analysis. Conclusions: The number of children hospitalized with pneumonia and incidence of common pathogen infections were both reduced, and that allergy and micronutrient status in children were also changed after the outbreak of the COVID-19 pandemic.

Australia’s national living guidelines for COVID-19 were launched in April 2020 and include over 200 recommendations to guide the clinical care of patients with COVID-19. Until the guidelines were retired in August 2023, new evidence was continually monitored through daily surveillance. This paper describes how evidence surveillance was established (at a time when efforts to collate information on the novel coronavirus were in their infancy and often duplicative) and how it evolved throughout the pandemic. Among the wide range of sources monitored, the collections of COVID-19 research from leading medical journals, medRxiv preprints and PubMed auto alerts proved the most enduring in identifying time-critical and impactful evidence. The paper also explores how evidence was tracked and surveillance integrated into the overall evidence workflow by using messaging apps and communication platforms. Several factors contributed to the feasibility of daily surveillance, including the clearly defined scope of the guidelines; focusing efforts on maximum impact; minimising duplication by partnering with others; setting up simple but effective processes for managing evidence; and the value of continuous involvement of personnel from the outset. The example of Australia’s living COVID-19 guidelines has demonstrated the feasibility and essential role of daily evidence surveillance in maintaining COVID-19 living guidelines for over 3 years.

A document by Mary Anissa Sinnathamby. Click on the document to view its contents.

The COVID-19 pandemic has required a rapid transformation in healthcare delivery, prompting a shift from traditional in-person services to digital platforms. This comprehensive review explores the transition of the clinic, a community-based pain clinic, to online services, examining the challenges, benefits, and implications for patient care and accessibility. This paper delves into the experiences of patients and providers, highlighting the role of digital health in improving accessibility and overcoming geographical barriers. The paper also addresses the behavioural changes required for effective online interactions and the importance of setting clear expectations to support virtual modalities for pain care. Through a review-based analysis, key themes and insights are identified, providing a nuanced understanding of the impact of digital transformation on pain management services to create an evidence-based discussion.

The exposure of human children to smartphone radiation has been rapidly increasing in the past few years because of the development of smartphones and smartphone networks. Additionally, global crises, such as COVID-19 lockdown, dramatically escalated electronic consumption of each individual human. Due to the relatively small head size, different anatomical structure, and different electromagnetic properties, a child head is expected to react differently to exposure to electromagnetic radiation compared to an adult head. This study presents a computational analysis of Specific Absorption Rate (SAR) and temperature distributions inside anatomical 7-year-old child head model exposed to sub-6 GHz fifth-generation mobile phone radiation. Four different frequencies (0.9 GHz, 1.8 GHz, 3 GHz, and 6 GHz) as well as two antenna positions (voice and video call) were investigated. Electromagnetic wave propagation equations and thermal energy balance equation were numerically solved inside the computational space with 1W antenna power. It is observed that for 6 GHz frequency in voice call position, peak SAR and temperature values of 22.5 W/kg and 8.14 °C, respectively, were obtained. However, the peak SAR and temperature points locations were not correlated. Also, peak temperature elevation surpassed 90% of its ultimate value within the first 5 minutes of exposure time.

The mid-term impact of SARS-CoV-2 infection on senescence profile and immune checkpoints biomarkers in people living with HIV (PLWH) was assessed. Cross-sectional study in 95 PLWH on ART stratified by SARS-CoV-2 infection: a) 48 PLWH previously infected (PCR+) (HIV/SARS); b) 47 PLWH controls without previous infection (HIV). Plasma biomarkers (n=44) related to cell immune checkpoint molecules, associated with the Senescence-Associated Secretory Phenotype (SASP), and related to pro and anti-inflammatory cytokines were assessed by Procartaplex Multiplex Immunoassays (Xmap-Luminex technology). Differences between groups were analyzed using a generalized linear model, adjusted by sex and ethnicity and corrected by false discovery rate. Significant values were defined as the adjusted arithmetic mean ratio ≥1.2 or ≤0.8; q-value<0.1. The relationship between plasma biomarkers was evaluated by Spearman correlation (significant correlations rho≥0.3 and q-value<0.1). PLWH had a median age of 45 years and 80% were men. All PLWH infected by SARS-CoV-2 had a symptomatic infection, 83.3% as mild, and with a median of 12 weeks after diagnosis of SARS-CoV-2 infection. HIV/SARS group showed higher levels of the cell immune checkpoint plasma biomarkers CD80, PDCD1LG2, CD276, PDCD1, CD47, HAVCR2, TIMD4, TNFRSF9, TNFRSF18, and TNFRSF14 respect to HIV group. The SASP biomarkers LTA, CXCL8, and IL13 and the inflammatory biomarkers IL4, IL12B, IL17A, CCL3, CCL4, and INF1A showed significantly higher levels in the HIV/SARS group. SARS-CoV-2 infection in PLWH leads to significant medium-term disruption in plasma immune checkpoint molecules and inflammatory cytokines, highlighting SASP-related. This could be a risk factor for the emergence of complications in PLWH.

COVID-19 caused substantial damage for the world and more than one million individuals succumbed to this contagious disease. During the 2020-2021 autumn-winter season, there was a huge wave of new COVID-19 infection cases in the United States (US). We intend to investigate whether this high COVID-19 burden had a link to adverse drug reactions in the US, thus we extracted online data from the US Food and Drug Administration (FDA) comparing the adverse drug effect-related mortality between two autumn-winter seasons (2020/2021 cohort 1 vs 2022/2023 cohort 2). The primary outcome is measured via multi-variable logistic regression models which adjust age, sex, and drug indication. A second analysis investigated the association between the high COVID-19 burden and the adverse drug effect mortality for the 25 most reported drugs during the two seasons. The average age is 58.87 vs 59.27 years, respectively. In Cohort 1 54.29% are females and in Cohort 2 the percentage is 55.32%. The crude mortality in Cohort 1 is 19.80% and in Cohort 2 it is 20.72%. We did not find a positively significant primary outcome and the odd ratio (OR) of high COVID-19 burden for adverse drug effect mortality is 0.946 (95%CI 0.926-0.965, p < .0001). However, the subgroup analysis shows for some drugs, most of which compromise the immune response, the high COVID-19 burden is linked to increased risk of death significantly. They include adalimumab, clozapine, duplilumab, lendlidomide, palbocicib, pomalidomide, rivaroxaban, tofacitib, ibrutinib, and updadacit. Our study probably provides preliminary evidence supposing that patients suffering an adverse drug effect involving the immune system from medications might be at increased risk for deteriorating outcomes during the high pandemic burden period of a serious and contagious disease. However, future prospective studies are needed to confirm the results. We think an adverse drug reaction mitigation strategy during future pandemics is needed to better protect those who take these drugs.

Weeks or months after recovering from COVID-19, a significant number of people are still experiencing fatigue, ‘brain fog’, headaches, cognitive impairment, smell or taste disturbances, myalgia and one or more other symptoms. This condition has been termed as Long COVID and dysautonomia is thought to play one of the important roles in the pathophysiology of this condition. The stellate ganglion block (SGB) is thought to restore autonomic nervous system functioning by temporarily inhibiting cervical sympathetic activity and is under investigation as a potential option for the treatment of persistent olfactory and gustatory dysfunction, headache and other symptoms of Long COVID. In this case series, we report that by performing SGB, we successfully treated and improved the quality of life of two patients with a Long COVID diagnosis who presented us with complaints of smell and taste sensory impairment.

COVID-19 vaccination and pregnancy: getting the word outVictoria Male, Senior Lecturer in Reproductive Immunology, Imperial College LondonPregnancy is a risk factor for severe COVID-19, doubling the likelihood that an unvaccinated individual requires intensive care, invasive ventilation, or ECMO. Between March 2020 and December 2021 in the UK, COVID-19 emerged as the leading cause of death during pregnancy: among the 33 women who succumbed to the virus, none had been fully vaccinated (Knight et al, ISBN: 978-1-7392619-4-8). Furthermore, in unvaccinated individuals, SARS-CoV-2 during pregnancy can adversely affect infants, increasing the odds of preterm birth by 1.5-fold and those of stillbirth or neonatal death by approximately 3-fold (Male, Nat Rev Immunol, 2022, 22:277-82).In the face of these concerning statistics, COVID-19 vaccination in pregnancy seems a sensible precaution. Clinical trials and subsequent observational studies demonstrated that COVID-19 vaccination is safe and effective in the general population, but expectant parents naturally have an important additional question: is it safe for my baby?In the clinical trials of the COVID-19 vaccines, pregnancy was an exclusion criterion but nonetheless 102 participants became pregnant during mRNA vaccine trials, with miscarriage rates no different between the vaccinated and control groups. Early observational studies focussed on outcomes at birth which, during the pandemic, have been somewhat better in vaccinated individuals, particularly with respect to outcomes influenced by SARS-CoV2 infection (Prasad, Nat Comms, 2022, 13:2412*). A population-based cohort study published in this issue of BJOG (please add reference) is the latest in a mounting number of observational studies that examine the risk of early pregnancy loss following COVID-19 vaccination, controlling for gestational age and relevant medical and social confounders. This is the first to formally consider termination of pregnancy at the patient’s request as a competing risk, but whether or not this was including in the analysis, the authors found no increased risk of miscarriage associated with COVID-19 vaccination either during or before pregnancy.The evidence is now clear: COVID-19 vaccination is safe in pregnancy, but infection is not. Despite this, COVID-19 booster uptake among those eligible due to pregnancy remains low, peaking at 19% in the 2022-23 booster season. Some people are not aware their pregnancy makes them eligible for a booster and, among those who are, not all are informed of the extensive evidence on the safety and benefits of COVID-19 vaccination in pregnancy. Others believe their primary course of vaccination, or a previous infection, is sufficient to protect them. Although a primary course of vaccination continues to protect against severe disease, evidence on how long protection lasts, particularly in the face of new variants, is not yet available: as time elapses the benefit of a booster is expected to increase. Pertinently, people continue to die of flu during and shortly after pregnancy, despite having been exposed to the virus throughout their lives. In the UK, two women recently died this way: neither had received the recommended flu booster during pregnancy (Knight et al, ISBN: 978-1-7392619-4-8).While ongoing research remains important for confirming the safety of COVID-19 vaccination during pregnancy, it is unlikely that any new study will overturn the wealth of evidence we have already amassed. The challenge now is to get the word out.* For a regularly updated list of studies concerning the safety of COVID-19 vaccination in pregnancy, please see http://bit.ly/pregnancysafety

COVID-19 is an acute respiratory disease that has become a pandemic worldwide. Many studies have been conducted to enhance our understanding of COVID-19. However, the abundance of information obtained from these studies has resulted in information overload. In this study, we purposed a simple COVID-19 Knowledge Graph in Bahasa Indonesia as a way to reconstruct knowledge to combat this information overload. We used Bahasa Indonesia in our study to explore its potential for constructing a Knowledge Graph (KG). The construction of our KG involved manual curation of medical literatures and annotation of entities and relationships by the domain experts. The KG was implemented using Neo4J version 5. We successfully demonstrated our COVID-19 KG, which consists of 240 nodes and 276 relationships with 15 and 14 node and relationship labels respectively. Accessing the information within the KG is made effortless through the use of Cypher queries in Neo4J. Further research is still needed to develop the KG into a larger and better one. However, our COVID-19 KG can serve as a basis for further development.

Abstract: Aim: Recent literature has shown epidemiological changes in bronchiolitis with an increased incidence in the post-SARS-CoV-2 pandemic period but reports regarding disease severity are conflicting. We aimed to describe the epidemiology, disease severity, and microbiology of bronchiolitis during the 2022-2023 cold season compared to the previous five years. Methods: This single-center retrospective observational study at IRCCS Gaslini, Italy, included all children aged 0-2 years hospitalized for bronchiolitis from September 1st, 2017, to August 31, 2023. Findings from the 2022-2023 season were compared to the previous five years. Results: We observed a statistically significant increase in the 2022-2023 season in the absolute number of bronchiolitis admissions. Children who required mechanical ventilation dramatically increased from a total of 7 patients in the previous five seasons to 17 in the 2022-2023 season alone ( p=0.001). All other severity parameters significantly increased: the need for respiratory support ( p=0.002) , the median length of stay (5 vs. 4, p=0.001), and the median duration of respiratory support (4 vs. 3, p=0.016). Conclusions: We report a substantial increase in the severity of bronchiolitis in the season 2022-2023 with a remarkable number of previously healthy infants requiring mechanical ventilation. Our data represents a call in our setting for urgent measures to plan prophylactic and therapeutic strategies and prepare healthcare systems. Further studies are needed to confirm whether our findings are an isolated phenomenon or part of a true global trend. Health systems need to be prepared and protective preventive measures should be implemented for all newborns.

The quick advancement of technology in internet communication and social media platforms eased several problems during the COVID-19 outbreak. It was, however, used to spread untruths and misinformation regarding the illness and the immunization. In this study, it is examined whether machine-learning algorithms (Naive Bayesian, Random Forest, Logistic Regression, Decision Tree, and Support Vector Machine, as well as Gradient Boost, Bagging, AdaBoost, Stochastic Gradient Descent, and Multi-layer Perceptron) can automatically classify and point out fake news text about the COVID-19 pandemic posted on social media platforms. The “COVID19-FNIR DATASET” was used to train, test, and fine-tune machine learning models in order to predict the sentiment class of each fake news item on COVID-19. The results were assessed using a variety of evaluation metrics (confusion matrix, classification rate, true positives rate, etc.). The findings collected demonstrate an extremely high level of accuracy when compared to other models.Â

Background: The leading cause in COVID-19 patients is development of cytokine storm .    Material and Methods: This study was conducted in a tertiary center with diagnosis of COVID-19 patients. Clinical and laboratory features of patients were obtained from their medical cards and hospital software system and evaluated by retrospectively.                    Statistical analysis: In our study, 21.0 version (IBM, Armonk, NY, USA) of the SPSS (Statistical Package for the Social Sciences) program was used for statistical analysis of data. Descriptive statistics, discrete and continuous numerical variables were expressed as mean, ± standard deviation or median and interquartile range (IQR). Categorical variables were expressed as number of cases and (%). Cross table statistics were used to compare categorical variables (Chi-Square, Fisher exact test). Normally distributed parametric data were compared with Student’s t-test and Paired t-test; non-parametric data that did not meet normal distribution were compared with Mann Whitney U and Kruskal Wallis tests. Multiple intergroup comparisons were made by Post Hoc Tukey analysis. Kaplan-Meier and log-rank methods were used for survival analysis. Multivariable analysis was performed by using logistic regression. Correlation analysis was performed with Pearson or Spearman method according to normality distribution.  p<0.05 value was considered statistically significant.   Results: Data of 15 patients in combination group and 43 patients in control group were evaluated and included into the study. Of these patients 73.3% was male in combination arm and 72.1% in control group (p=0.9). Demographic findings and frequency of comorbidities were similar between two groups (table 1). Overall mortality was 46.7% (n=7) in combination arm and 69.8% (n=30) in control group although it was not statistically significant (p=0.1). Similarly, need of intubation was also lower in combination arm (46.7%) compared to control group (69.8%), it was not significantly different (p=0.1). ICU admission was significantly lower in combination (46.7%, n=7) arm than control group (76.7%, n=33) (p=0.03, Odds ratio [OR]:4.7). Development of severe infection (20%, n=3 vs 25%, n=9/36), pulmonary embolism (6.7%, n=1 vs 0), myocardial infarction (6.7%, n=1 vs 2.6%, n=1/38) and pneumothorax (13.3%, n=2 vs 2.6%, n=1/38) were not different between two groups (p=0.7, p=0.3, p=0.5 and p=0.2). In multivariable analysis only cHIS score was associated with high mortality (p=0.018, OR:2.8, [95% confidence interval: 1.2-6.6]). In survival analysis, mortality rate was significantly lower in combination arm than control group (Log-Rank:p=0.04;figure 1). In conclusion, combination therapy of high-dose anakinra and baricitinib may be an adequate treatment option in patients with COVID-19 who had critical disease and no additional safety signal.

Background: mRNA-containing, PEGylated Covid-19 vaccines can cause hypersensitivity reactions (HSRs), or rarely, life-threatening anaphylaxis in a small fraction of immunized people. A causal role of anti-PEG antibodies (Abs) has been proposed but not yet proven in a large animal model. Methods: Domestic pigs (n=6) were immunized with 0.1 mg/kg PEGylated liposome (Doxebo) i.v., and the rise of anti-PEG IgG and IgM were measured in serial blood samples with ELISA. During the plateau of seroconversion, in the 1-3 weeks postvaccination period, the animals were injected i.v. with 1/3 human dose of the PEGylated mRNA vaccine, Comirnaty, and the hemodynamic (PAP, SAP, pulse pressure), cardiopulmonary (HR, EtCO2,), hematological (WBC, granulocyte, lymphocyte and platelet counts) parameters and blood immune mediators (anti-PEG IgM and IgG antibodies, thromboxane B2, C3a) were measured as endpoints of anaphylaxis. Results: In about a week, the level of anti-PEG IgM and IgG rose 5-10-thousand-fold in all of 6 pigs immunized with Doxebo, after which time all animals developed anaphylactic shock to i.v. injection of 1/3 human dose of Comirnaty. The reaction, starting within 1 min, involved maximal pulmonary hypertension, decreased systemic pulse amplitude, tachycardia, granulopenia and thrombocytopenia. These physiological changes were paralleled by C3a and TXB2 rises in blood and were absent in non-immunized pigs. Conclusions: Consistent with previous studies, these data show a causal role of anti-PEG Abs in the anaphylaxis to Comirnaty. Based on the involvement of C activation and identity of symptoms with those observed in pseudoallergy to PEGylated liposomes, the reaction represents C activation-related pseudoallergy (CARPA). The applied sensitization of the porcine CARPA model may help better understand these reactions, and, thus, make Comirnaty and other mRNA-LNP-based Vaccines and PEGylated Nanopharmaceuticals safer.