The end of the 2019/2020 influenza season was already registered in early summer 2020, and in the following season. There was an nearly complete absence of influenza. So far, the sometimes strict Covid-19 containment measures with contact restrictions and the obligation to wear a mask have been mentioned as reasons. This study looks for further reaseons and from several perspectives in order to develop strategies for a representative recording of influenza cases derive. In contrast to influenza A/B, the other viral respiratory pathogens (adenovirus, parainfluenza virus and RS virus) do not show any significant reduction. From 2020, the number of reports of respiratory infections to the RKI increased from an average of 300,000 annual reports by 2019 to 1,985,985 reports in 2020, over 5,453,017 reports in 2021 and to 29,681,158 in 2022. On the other hand cases of incapacity to work due to respiratory infections fell from 31.0% in 2019 to 15.3% in 2021. Influenza-specific diagnoses (ICD: J10.1-3) were encrypted 33,727 times in 2021, in 2020 there were still 109,846. The reduction in influenza A and B from 2020 as a result of the comprehensive Covid-19 control measures, including the obligation to wear masks, cannot be considered a major reason; rather, the aspect of underreporting of influenza cases plays a significant role. Therefore, the reporting quantity of the sentinal practices should be considered and the recording of incapacity diagnoses should be taken into account.

Background: As the ongoing public health crisis from Coronavirus Disease 2019 (COVID-19) pandemic puts strains on current models of cancer care, many health care centers had to adapt to minimize the risk of exposure and infection. The effects of the COVID-19 pandemic in a comprehensive cancer center were determined. Purpose: To measure the impact of the COVID-19 pandemic on care delivery at a comprehensive cancer center. Methods: The number of on-site and telehealth visits (TH) were obtained from scheduling software. Multiple factors including total visits, telehealth visits, screenings for cancer diagnosis, and cancer treatments were tracked from two years before the pandemic onset through 2022. The length of stay (LOS) and Case Mix Index (CMI) were calculated using hospital database. Results: In the third quarter of FY 2020, telehealth visits (TH) represented a fifth of total patient encounters. Cancer treatments, such as chemotherapy, radiation therapy, and surgery, decreased during the pandemic with number of surgeries being most affected (23% decrease in 2020 compared to the previous fiscal year). The average length of stay (LOS) was also longer with less discharges per given time during the pandemic. The increased LOS was related to increased severity of patient illnesses since CMI was higher. Screening mammograms decreased to a nadir of 58% in 2021 as compared to those screened in pre-pandemic fiscal years. Conclusions : The COVID-19 pandemic impacted many aspects of care, such as treatment and screenings. Many of these factors had to be postponed due to the fear of acquiring COVID-19 and access to care. The findings presented implicate that the delays and changes in cancer care during the pandemic resulted in less screening and treatment of more advanced disease.

The immune deregulation and disease-modifying anti-rheumatic drugs (DMARDs) make patients with autoimmune rheumatic diseases (ARD) more susceptible to infection. We aimed to investigate the prevalence and clinical outcome of COVID-19 in ARD patients with different treatments. PubMed, Embase, Medline, Cochrane Library, Web of Science were searched to identify the relevant evidence up to March 20, 2023. The overall prevalence of COVID-19 in ARD patients was 0.061. The ARD patients with glucocorticoids (GC) treatment had the highest prevalence[0.088(95%CI:0.065-0.110)] compared to biological (b) DMARDs[0.041(95%CI:0.031-0.051)], conventional synthetic (cs) DMARDs[0.055(95%CI:0.043-0.067)], and anti-TNF therapy[0.029(95%CI:0.003-0.056)]. In contrast, those receiving anti-TNF therapy had the lowest prevalence. The overall hospitalization rate, ICU admission rate, and mortality of ARD patients due to COVID-19 were 0.402(95%CI:0.330-0.476), 0.077(95%CI:0.051-0.107), and 0.073(95%CI:0.046-0.104). Using bDMARDs had lower hospitalization rates[0.216(95%CI:0.147-0.286)], ICU admission rates[0.010(95%CI:0.000-0.037)], and mortality[0.039(95%CI:0.007-0.087)]. Regression analysis showed a significant negative relationship between bDMARDs monotherapy and ICU admission rates(regression coefficient:-0.156, 95%CI:-0.260 - -0.051, P=0.006). Patients using csDMARDs had higher hospitalization rates[0.607(95%CI:0.450-0.755)], ICU admission rates[0.055(95%CI:0.037-0.075)], and mortality[0.074(95%CI:0.041-0.114)]. Patients using GC had a higher hospitalization rate[0.703(95%CI:0.449-0.910)], higher ICU admission rate[0.094(95%CI:0.046-0.152)], and lower mortality[0.070(95%CI:0.033-0.114)]. Regression analysis showed a significant positive correlation between GC monotherapy and hospitalization(regression coefficient:0.484, 95%CI:0.146-0.822, P=0.006). For ARD patients, csDMARDs were associated with disease severity in COVID-19, bDMARDs were associated with a reduced risk of severe disease, and GC was effective in patients with severe COVID-19-related respiratory failure.

Introduction: In this paper we examine the relationship between vaccination against COVID-19 and both the death rate from COVID-19 and the rate of COVID-19 spread. Our goal is determine if vaccination is associated with reduced death and/or spread of disease at the local level. Methods: This analysis was conducted at the county level in the state of Pennsylvania, United States of America, with data that were collected during the first half of 2022 from the state of Pennsylvania’s Covid Dashboard ([COVID-19 Data for Pennsylvania (pa.gov)](https://www.health.pa.gov/topics/disease/coronavirus/pages/cases.aspx) . Result s: Given that, during this time period, the vaccines being used were not geared specifically toward the common variants at that time, we found no statistically significant relationship between disease spread and vaccination rate at the county level. That said, we did find a highly statistically significant relationship between death rate and vaccination rate (p-value = 0.006). Specifically, a 1% increase in vaccination rate was found to correspond to a 0.751% decrease in death rate (95% confidence interval (0.236%, 1.266%)). Conclusions: These results support previous findings from across the world that Covid vaccination is highly efficacious in preventing death from the disease. Even during a time when vaccine design was not optimally matched with the prevailing strains, vaccination was found to reduce death rate. Hence, improving global vaccine availability is vitally important, in order to achieve necessary outcomes.

Background: Vaccination is a proven method of managing the COVID-19 pandemic and it is essential to prevent negative consequences in pregnant, lactating, and reproductive-age populations. The study aims to identify the rates of COVID-19 vaccine acceptance, the reasons for receiving and not receiving the vaccine, and the associated factors among pregnant, lactating, and non-pregnant women of reproductive age. Methods: This cross-sectional and analytical study was conducted online in Turkey, at the end of the fourth wave of the COVID-19 pandemic, between February-May 2022. A total of 658 participated in the study. The Question Form and the Fear of COVID-19 Scale were used to collect data. Results: Vaccine acceptance rates were 91.7% in non-pregnant women of reproductive age, 77% in lactating women, and 59% in pregnant women (p<0.05). The highest rate of vaccine hesitancy was observed in pregnant women (31.3%), and the vaccine rejection rate was the highest in lactating women (10.2%). For pregnant women (55.5%) and non-pregnant women of reproductive age (56.4%), the primary reason for the acceptance of the vaccine had no other choice but to be protected against the disease, while for lactating women (50.6%), the primary reason for receiving the vaccine was protecting the baby. Conclusion: Lack of knowledge about and confidence in the COVID-19 vaccine is still one of the barriers to vaccine acceptance today. Health care providers (HCPs) should provide effective counseling to pregnant, lactating, and non-pregnant reproductive-aged women based on current information and guidelines.

Objectives In a COVID-19 sero-surveillance cohort study with predominantly healthy and vaccinated individuals, the objectives were (i) to investigate longitudinally the factors associated with the quantitative dynamics of anti-spike IgG antibody levels, (ii) to evaluate whether the antibody levels were associated with protection from SARS-CoV-2 infection and (iii) to assess whether the association was different in the pre-Omicron compared with the Omicron period. Methods The QuantiVac Euroimmun ELISA test was used to quantify anti-S1 IgG levels. The entire study period (16 months), the 11-month pre-Omicron period and the cross-sectional analysis prior to the Omicron surge included 3219, 2310 and 895 reactive serum samples from 949, 919 and 895 study participants, respectively. Mixed-effect linear, mixed-effect time-to-event and logistic regression models were used to achieve the objectives. Results Age and time since infection or vaccination were the only factors associated with a decline of anti-S1 IgG levels. Antibody levels were significantly associated with protection from SARS-CoV-2 infection, and the association was higher for the Omicron than for the Alpha and Delta variants. In a prediction model, it was estimated that >8000 BAU/mL anti-S1 IgG was required to reduce the risk of infection with Omicron variants by 20% to 30% for 90 days. Conclusions Anti-S1 IgG antibody levels are associated with protection from infection. The levels in the pre-Omicron periods were less significant than during the Omicron surge, which in turn required very high levels for protection in a statistical model.

This study aimed to investigate the relationship between personality characteristics and psychological health of hospitals’ frontline medical staff and provide a basis and reference for targeted psychological health education for frontline medical staff and for the staff of related departments to formulate relevant policies. The self-evaluation scale of symptoms (SCL-90) was used to investigate the mental health status of 150 first-line medical staff in Zhejiang Province in response to the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia.The average scores of SCL-90 and somatization, obsessive-compulsive, depression, anxiety, hostility, terror, and psychotic factors were significantly higher than those of the normal sample in the first-aid medical staff of Aihu Hubei. The degree of influence on the mental health status of the frontline medical staff in service in Hubei is as follows, from high to low: the degree of suspicion that they may have been infected when new coronavirus pneumonia-related symptoms occur, the degree of fear of being infected and thus bring the infection to their families, and whether they have received a medical check-up recently, as well as a high level of education (both P<0.05).The psychological health level of the frontline medical staff is lower than the national norm. In the context of the increasing number of confirmed cases and the new type of coronavirus pneumonia in the absence of any specific curative treatments, the frontline medical staff is under great psychological pressure. It is necessary to institute targeted mental health promotion to relieve the psychological pressure endured by the frontline medical staff, promote their physical and mental health, and better respond to the pandemic in China.

Objectives: Circulating nucleocapsid (NCP) antigen of SARS-CoV-2 is increased in severely ill COVID-19 patients. However, clinical deterioration of COVID-19 often happens about one week after benign initial presentation. The role of NCP antigenemia as a biomarker in those cases remains unclear. We investigated NCP clearance kinetics in hospitalized patients as a risk assessment tool for predicting necessity of intensive care treatment of COVID-19 patients. Methods: Serum NCP was quantified using a commercial NCP-specific ELISA in hospitalized COVID-19 patients (n=63) during their hospital stay. Results were correlated to COVID-19 disease severity, inflammation parameters, antibody response and results of SARS-CoV-2 PCR from nasopharyngeal swabs.   Results: We demonstrate that NCP antigen levels in serum remained elevated in 45.6% of patients requiring treatment on intensive care units (ICU) after >8 days post positive SARS-CoV-2 PCR, compared to complete clearance in all non-ICU patients. This was in contrast to mucosal clearance of virus as measured by PCR. Antigen clearance was associated with higher IgG against S1 but not NCP.   Conclusions: Detection of NCP antigenemia after 8 days post COVID-19 diagnosis identifies patients who will require intensive care. Lack of NCP clearance after one week can thus help to assess the risk to develop severe COVID-19.

The “Severe Acute Respiratory Syndrome Coronavirus 2” (SARS-CoV-2) causes potentially fatal disease.The Covid-19 vaccine is the most effective weapon to reduce the virus spread. We describe a rare post-vaccine effect like Guillian Barré Syndrome. We reported a 66-years-old female patient with acute manifestations four weeks after vaccine administration.

The role of hydroxychloroquine (HCQ) in lowering the viral load of patients with COVID-19 is controversial. In our Institute, we treated more than 30,000 people with COVID-19 in 2020 and 2021, using the same diagnostic tools and the same treatment dosages. In this retrospective comparative study of data collected over this period, we aimed to compare the viral clearance in the nasopharynx as determined by qPCR in patients who were treated with HCQ and those who were not. As a new feature, we adjusted the data according to the most significant confounding factors (age, initial viral load, and timescale between the onset of symptoms and treatment). Of the 1 276 patients selected from our database, 776 were treated with HCQ and 500 were not. Viral clearance in the treatment group was reached significantly earlier than in the non-treatment group, at days 5, 10 and 30. These differences remain significant after adjustments for confounding factors. In conclusion, although age, initial viral load, and time to treatment do influence the viral load in patients with COVID-19, hydroxychloroquine associated with azithromycin still independently significantly lowered viral load more rapidly than other treatments, including azithromycin alone.

Background and Purpose: The Bazhen decoction is one of the most extensively used Traditional Chinese medicine (TCM) prescriptions for anti-aging. However, due to the complicity of the components, the pharmacological mechanism of Bazhen decoction is still limited. Experimental approach: We applied RNA sequencing and transcriptome analysis to get the full view of the signaling pathways regulated by Bazhen decoction in the wild type cell background. By using the progeroid cells derived from Werner syndrome mice, we applied Western blot, Immunofluorescence, flow cytometry and telomere FISH to verify the transcriptome data. Key Results: The transcriptome profile revealed that Bazhen decoction might systematically regulate multiple anti-aging pathways, including stem cell regulation, protein homeostasis, cardiovascular function, neuronal function, anti-inflammation, anti-DNA damage induced stress, DNA helicase activity and telomere lengthening. We found that multiple DNA helicases and telomere regulating proteins were up-regulated by Bazhen decoction, which promoted the resolving of G-quadruplex (G4) structure, and facilitated DNA replication and telomere elongation. These improvements also endowed the cellular resistance to DNA damages induced by replication stress. Together these data suggest that Bazhen decoction facilitate G4 resolving and telomere maintenance, which might contribute to the longevity sustaining properties revealed by transcriptome profile. Conclusions & Implications: Our data revealed a new strategy for recovering the pharmacological signature pathways for TCM, which could help the clinical precision medicine of TCM. By applying transcriptome in TCM-treated normal cell, we tried out a systematic analysis for dissecting the molecular mechanism of complicated TCM prescription in the normal genetic background.

Background: To investigate the distribution of bacterial pathogens of lower respiratory tract infection (LRTI) in hospitalized elderly patients during the COVID-19 epidemic and to explore the influence of COVID-19 on the distribution of bacterial pathogens, in order to provide guidance for clinical diagnosis. Methods: Specimens of sputum from elderly LRTIs patients at Fuding Hospital of China were collected from October 2022 to January 2023. Cultures and identification were done, and RT-PCR was employed to detect SARS-Cov-2 nucleic acid. Results: A total of 195 isolates were characterized in 163 sputum samples of consecutive hospitalized elderly patients, of which 11.3% were Gram-positive bacteria and 88.7% Gram-negative. The top of frequently isolated pathogens were Klebsiella pneumonia (30.3%), Pseudomonas aeruginosa (19.0%), Acinetobacter baumannii (12.8%), Stenotrophomonas maltophili, (7.7%), Escherichia coli (7.2%). According to the results of novel coronavirus nucleic acid detection, the 163 patients were divided into COVID-19 group and non-COVID control (CNT) group. The comparison of bacterial distribution between the groups revealed that Stenotrophomonas maltophilia was lower in the COVID-19 than in the CNT group, while Acinetobacter baumannii was higher in the COVID-19 group, and the difference was statistically significant (P < 0.05). Conclusion: The major bacteria identified in sputum culture of hospitalized elderly patients were Klebsiella pneumonia, Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia, and Escherichia coli. Furthermore, the distribution of Stenotrophomonas maltophilia and Acinetobacter baumannii between the COVID-19 and CNT groups was found to be significantly different (P< 0.05), while there were no significant differences in the distribution of other bacteria.

Background: People with cystic fibrosis (PwCF) have chronic lung disease and may be at increased risk of COVID-19-related morbidity and mortality. This study aimed to determine seroprevalence and clinical characteristics of SARS-CoV-2 infection in children with CF, and to assess antibody responses following SARS-CoV-2 infection or vaccination. Methods: Children and adolescents with CF followed at Seattle Children’s Hospital were enrolled between July 20, 2020 and February 28, 2021. SARS-CoV-2 serostatus was determined on enrollment, at 6 and 11 months (+/-2 months) for nucleocapsid and spike IgG. Participants completed intake and weekly surveys inquiring about SARS-CoV-2 exposures, viral/respiratory illnesses, and symptoms. Results: Of 125 PwCF enrolled, 14 (11%) had positive SARS-CoV-2 antibodies consistent with recent or past infection. Seropositive participants were more likely to identify as Hispanic (29% vs 8%, p=0.04) and have pulmonary exacerbations requiring oral antibiotics in the year prior (71% vs 41%, p = 0.04). Five seropositive individuals (35.7%) were asymptomatic, while six (42.9%) reported mild symptoms, primarily cough and nasal congestion. Anti-spike protein IgG levels were approximately 10-fold higher in participants following vaccination compared with participants who had natural infection alone (p < 0.0001) and resembled levels previously reported in the general population. Conclusions: A majority of PwCF have mild or no symptoms of SARS-CoV-2 making it difficult to distinguish from baseline respiratory symptoms. Hispanic PwCF may be disproportionately impacted, consistent with racial and ethnic COVID-19 disparities among the general US population. Vaccination in PwCF generated antibody responses similar to those previously reported in the general population.

During the Covid-19 pandemic, the morbidity of anorexia increased both in its scope and in its severity. Research conducted thus far, has raised questions regarding the unique influences that the pandemic imposed on individuals with anorexia and those at risk for developing it. This opinion article offers a psychoanalytic understanding for the increased morbidity of anorexia following the outbreak of COVID-19. It argues that the encounter between an external reality saturated with restrictions and prohibitions and the anorexic internal reality intensified the anorexic symptomology. The authors present explanations regarding the ways in which the pandemic undermined the anorexic defenses and contributed to the increase of anorexia. They conclude that COVID-19 has led to the exacerbation of anorexia through employment of two key defense mechanisms of anorexia, which are: 1. Implementation of prohibitions, reductions, and restrictions. 2. Having an omnipotent sense of self, in which the body is regarded as controllable.

Widespread school closures and other non-pharmaceutical interventions (NPIs), used to limit the spread of SARS-CoV-2, significantly disrupted transmission patterns of seasonal respiratory viruses. As NPIs were relaxed, populations were vulnerable to resurgence. This study within a small community assessed acute respiratory illness among kindergarten through grade 12 students as they returned to public schools from September through December 2022 without masking and distancing requirements. The 277 specimens collected demonstrated a shift from rhinovirus to influenza. With continued circulation of SARS-CoV-2 and return of seasonal respiratory viruses, understanding evolving transmission patterns will play an important role in reducing disease burden.

Clinical Validity and Conceptual Interpretation of Impact of alcohol consumption on COVID-19 severityRama Jayaraj 1*, Sameep Shetty 2, A Devi3, Suja S4, Yash Merchant5

This study explores the development and testing of a social resilience psychometric scale, through physical and social unrest during the COVID-19 pandemic. Qualitative interviews (N = 40) were aggregated to define social resilience measured statements. When tested in quantitative analysis respondents (N = 901) “see myself as a monster” when evaluating others and are “scared to let people know the real me” fearing loss of relationships. Anxiety is heightened through a perception through the measure “could have done better.” When testing for “want to be liked even when disagree on issues” Black respondents are significantly different than White, Asian and those expressing other races. Liberals and moderate conservatives are significantly different in perception of social resilience, as are those exemplifying feminine versus masculine traits. Logistic regression testing for “comfortable with who I am in society” indicates narcissism (65% more likely) and negative social resilience (56% more likely) are key adapters. Human wellbeing, the act of perceiving self as a healthy or unhealthy actor in society, has been influenced through groupthink and polarization of the “other.” This study suggests the construct of self-esteem has been pushed into reactive mode. Research that explicates the psychological dimensions of modern resilience, is warranted.

Objectives: To evaluate cellular immune responses induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines immunization in population based on HLA-E-restricted CD8 + T cell epitopes identification. Methods: HLA-E-restricted SARS-CoV-2 CD8 + T cell nonamer peptides were predicted with software. HLA-E-transfected K562 cells binding assay was used to screen for high-affinity peptides. IFN-γ enzyme-linked immunospot assay were used to identify HLA-E-restricted epitopes. HLA-E/epitope tetramer was employed to detect the frequencies of epitope-specific CD8 + T cells. Results: Four CD8 + T cell epitopes on spike protein of SARS-CoV-2 restricted by both HLA-E*0101 and E*0103 were identified. HLA-E-restricted epitope specific IFN-γ-secreting CD8 + T cell responses could be detected in individuals vaccinated with SARS-CoV-2 vaccines. Importantly, the frequencies of epitope-specific CD8 + T cell in Ad5-nCoV vaccinated individual were higher than that in individuals vaccinated with recombinant protein or inactivated vaccines. Moreover, frequencies of epitope-specific CD8 + T cells could maintain for at least 120 days after only one dose Ad5-nCoV vaccination. While frequencies of epitope-specific CD8 + T cells decreased in individuals after two doses of Ad5-nCoV vaccination. Conclusions: These findings may contribute to more comprehensive evaluating protective effects of vaccines for SARS-CoV-2, meanwhile may provide information to characterize HLA-E-restricted CD8 + T cell immunity against SARS-CoV-2 infection.

Background: No study has directly compared the efficacy of nirmatrelvir-ritonavir and azvudine for treatment. The efficacy of these two drugs at high altitudes was compared. Materials and Methods: This was a retrospective cohort research on hospitalized patients with COVID-19 who were treated with nirmatrelvir-ritonavir or azvudine in Tibet between August 1 and September 30, 2022. Results: The electronic health data of 731 patients were retrospectively reviewed. Nirmatrelvir-ritonavir and azvudine groups enrolled 338 and 147 patients, respectively. Among patients with mild, common, and severe (including critical) COVID-19, there was no difference in the median duration of hospitalization between treatment with nirmatrelvir-ritonavir and that with azvudine: 8 (5–10.25) vs. 9 (5–13) (P=0.096); 8 (5–11) vs. 8 (5–13) (P=0.227); and 13 (7–17.75) vs. 10 (7.5–17.5) (P=0.994) days, respectively. Moreover, patients in the nirmatrelvir-ritonavir group had a shorter median time for nuclear acid negative conversions (NANC) than those in azvudine group: 6 (4–9) vs. 10 (6.25–13.75) (P=0.000), 8 (5–12) vs. 10.5 (7–14) (P=0.013), and 7 (5.25–12.75) vs. 15 (7.5–23.5) (p=0.023) days, respectively. Conclusion: Azvudine yielded a longer time for NANC and an equivalent duration of hospitalization and may have comparable efficacy with nirmatrelvir-ritonavir, making it a viable treatment option for COVID-19.

Over 645 million people worldwide have been infected with SARS-CoV-2, the virus that causes COVID-19. Critical knowledge gaps regarding the characteristics, duration, and impact of symptoms due to “long COVID”. This study evaluated the persistence of symptoms at one year following hospitalization with COVID-19, comparing responses on standardized measurement tools to population norms. Adults hospitalized with COVID-19 March-October 2020 during the initial emergence period in Southeast Michigan were eligible. A detailed survey was conducted via telephone 9-15 months after hospital discharge. Questions assessed fatigue, dyspnea, and physical functioning related to their COVID-19 illness. The median World Health Organization Disability Assessment Schedule (WHODAS) polytomous score placed 50% (n=20/40) of participants in the 90 th percentile of disability based on population norms. The mean SF-36 physical functioning score was almost nine points below population norms (mean=70.6, standard deviation=27.4). Additionally, 47.5% of individuals (n=19) were severely emotionally affected by their health condition. Over half of participants surveyed were still impacted a year after initial infection, experiencing limited functional ability, fatigue, and emotional difficulties. Given the impact of these symptoms on day-to-day quality of life, further studies are needed to develop strategies for treatment and management of post-COVID conditions.

Objective: To explore the effects of antenatal anxiety on fetal growth, and to investigate the effect of anxiety timing and the potentially different effect of trait anxiety and state anxiety on fetal growth. Design: Observational cohort study. Setting: Barcelona, Spain. Population: A cohort of 204 women with singleton pregnancies attending the antenatal clinic of a tertiary care setting during the strict lockdown of the COVID-19 pandemic in 2020. Methods: Psychosocial factors, maternal demographics, and obstetric outcomes were studied as potential predictors of low birth weight. The State-Trait Anxiety Inventory (STAIs, STAIt), the Edinburgh postpartum Depression Scale (EPDS) and the Medical Outcomes Study Social Support Survey (MOS-SSS) were used to assess symptoms of anxiety, symptoms of depression, and social support, respectively. Main Outcome Measures: Neonatal birth weight, head circumference and length. Results: There was a negative correlation between STAIt score (trait anxiety) and birth weight percentile (r=-0.228, p=0.047). In the univariate linear regression analysis, a lower maternal weight and BMI before pregnancy, parity, increased STAIt score and preterm birth below 37 weeks of gestation (p=0.008, p=0.015, p=0.028, p=0.047 and p=0.022, respectively) were identified as predictive risk factors for low birth weight. In the multivariate lineal regression analysis only a lower maternal weight before pregnancy and an increased STAIt score were independent predictors for low birth weight (p=0.020, p=0.049, respectively). Conclusions: Anxiety during pregnancy impacts birth weight, and specifically the trait anxiety, the one associated with the personality attributes, is a predictor for low birth weight.

Title pageTitle: Rust-colored patches of the lower extremity in a COVID-19 patientAuthrors: Jacem Rouatbi1, Mouna Korbi1*, Nouha Ben Abdeljalil2, Hichem Belhadjali1*, Jameleddine Zili1*

A Case of TAFRO syndrome after COVID-19 vaccinationHitomi Hirosea, Hitoshi Suzukia,c*, Yukako Umezawaa, Masako Iwasakia, Hiromitsu Fukudaa, Hisatsugu Takaharaa, Shigeki Tomitab, Yusuke Suzukica. Department of Nephrology, b. Department of Pathology, Juntendo University Urayasu Hospital, Chiba, Japan. c. Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan.Correspondence to:Hitoshi Suzuki, M.D., Ph.DDepartment of Nephrology, Juntendo University Urayasu Hospital2-1-1 Tomioka, Urayasu-shi, Chiba 279-0021, JapanEmail: shitoshi@juntendo.ac.jpKey words: COVID-19, mRNA vaccine, TAFRO syndrome, renal dysfunction

Background: Chronic rhinosinusitis (CRS) is a heterogeneous disease characterized by persistent sinonasal inflammation and sinus microbiome dysbiosis. Nasal polyps (NPs) is one of the main manifestations which cause diverse clinical symptoms of CRS. We conducted a bibliometric and visual analysis of CRS and NPs articles published between 2003 and 2022 to provide researchers with the current state of research and potential directions. Method: We used a systematic search strategy to search relevant articles in the databases of the Web of Science from 2003 to 2022. VOSviewers, Bibliometrix R package, and CiteSpace were used to perform the bibliometric analysis. Results: 3,907 publications, including 3,266 “articles” and 641 “reviews” were retrieved. The USA made the highest contributions to global research, followed by China; furthermore, Northwestern University, Capital Medical University, and Sun Yat-Sen University had the highest number of publications. A total of 12,894 authors participated in this research, with the most published author being Bachert C., followed by Schleimer Robert P. and Schlosser Rodney J.. And the authors with the most co-citations were Bachert C., Fokkens W.J., and Gevaert P. 428 journals had published the articles of this research. Moreover, the journal with the most publications was the International Forum Of Allergy & Rhinology and the Journal Of Allergy And Clinical Immunology received the most citations. “Covid-19”, “biologic”, and “type 2 inflammation” were the top current research hotspots. Conclusion: The United States and Northwestern University were the leading country and institution in researching CRS and NPs. And Bachert C. is the most influential expert. The International Forum Of Allergy & Rhinology published the most articles, and the Journal Of Allergy And Clinical Immunology got the highest number of citations. Moreover, “Covid-19”, “biologic”, and “type 2 inflammation” were the trending topics.