Infectious Research Articles

A case of early childhood caries from a Medieval site in Southern Portugal: a multidisciplinary approach.

Dental caries is the most prevalent chronic infectious disease during childhood both in historical and contemporary times, but research focused on the oral health of non-adults from the past is still scant. As such, this study proposes a multidisciplinary approach to the differential diagnosis of severe dental lesions in a medieval non-adult skeleton. The skeleton of a three-year-old child recovered in the medieval necropolis of Cacela Velha (Portugal) was studied through macroscopic, radiological, elemental and stable isotope analyses. This individual exhibited enamel destruction and dentine exposure in both the maxillary and mandibular teeth, with the latter also showing changes in coloration. Elemental analysis showed that his skull presented lower values of Si, Cl, and Ca and higher of Cu compared to the control, while the concentration of P and S were significantly lower in the teeth. Early childhood caries is the most probable diagnosis for the dental lesions observed, apparently stemming from a reticulate of factors that include potential malnutrition, and the consumption of sugars in complementary feeding - even though historical sources point to the scarcity of sugar in Portugal during most of the Middle Ages.

NLRP3 Inflammasomes: Dual Function in Infectious Diseases.

The Nod-like receptor family pyrin domain containing 3 (NLRP3) inflammasome has been the most distinctive polymer protein complex. After recognizing the endogenous and exogenous danger signals, NLRP3 can cause inflammation by pyroptosis and secretion of mature, bioactive forms of IL-1β and IL-18. The NLRP3 inflammasome is essential in the genesis and progression of infectious illnesses. Herein, we provide a comprehensive review of the NLRP3 inflammasome in infectious diseases, focusing on its two-sided effects. As an essential part of host defense with a protective impact, abnormal NLRP3 inflammasome activation, however, result in a systemic high inflammatory response, leading to subsequent damage. In addition, scientific evidence of small molecules, biologics, and phytochemicals acting on the NLRP3 inflammasome has been reviewed. We believe that the NLRP3 inflammasome helps us understand the pathological mechanism of different stages of infectious diseases and that inhibitors targeting the NLRP3 inflammasome will become a new and valuable research direction for the treatment of infectious diseases.

Why Countering Harmful Industry Impacts and Exposures on Health is Critical for Environmental Justice and Reducing Non communicable Diseases

Why Countering Harmful Industry Impacts and Exposures on Health is Critical for Environmental Justice and Reducing Non communicable Diseases

Association Between Preventive Behavior for Infectious Diseases and Social Determinants of Health in a multiethnic community of Bangladesh

Association Between Preventive Behavior for Infectious Diseases and Social Determinants of Health in a multiethnic community of Bangladesh

Expert recommendations for internet medical care treatment of tuberculosis

Tuberculosis, a chronic infectious disease caused by Mycobacterium tuberculosis, has long posed significant challenges to both medical professionals and patients in its diagnosis and treatment. The need for regular follow-up visits has resulted in a significant economic and logistical burden for patients and a strain on healthcare resources. However, the recent rapid development of Internet technology has significantly enhanced the role of telemedicine in the health care of tuberculosis. This proposal aims to provide a comprehensive overview of the various aspects of telemedicine in the management of tuberculosis. It covers functional positioning, medical qualifications, scope of application, management team, operational model, medical standards, medication evaluation, precautions, risk management. It is intended to serve as a reference for healthcare professionals in the practical application of telemedicine in tuberculosis care.【Expert Recommendation 1】: To provide the further online services for tuberculosis patients who have already had a face-to-face consultation and been diagnosed with tuberculosis. Telemedicine in tuberculosis care includes confirmation of diagnosis, treatment, health counseling, management, educational initiatives, and the initial assessment and management of new symptoms and signs.【Expert Recommendation 2】: The qualifications for telemedicine in tuberculosis care require that the attending physician has a valid medical license and has at least three years of clinical experience in tuberculosis.【Expert Recommendation 3】: The primary target group for online tuberculosis care are patients who are undergoing routine follow-up visits. Certain examinations and test results are mutually recognized within certain regions.【Expert Recommendation 4】: The management team for telemedicine in tuberculosis care is consist of specialist physicians from tuberculosis medical institutions or third-party internet medical organizations, together with information technology staff.【Expert Recommendation 5】: The informatization framework for telemedicine in tuberculosis care includes referrals between higher and lower-level institutions, as well as online and offline referrals. Methods for online follow-up consultations include text-based and video consultations.【Expert Recommendation 6】: Standards for telemedicine in tuberculosis care must be in line with government documents. Regular monitoring and evaluation of the safety and efficacy of anti-tuberculosis therapy is needed, with guidance for patients to seek further treatment at an offline medical institution if necessary.【Expert Recommendation 7】: The attending physician must comply with regulations when documenting patient care and issuing prescriptions, which are valid only after review and approval by a pharmacist.【Expert Recommendation 8】: Healthcare providers are encouraged to use digital platforms, including social media, short video platforms, and mini-programs, to disseminate health information to patients and their families.【Expert Recommendation 9】: If the attending physician discovers adverse events in internet medical treatment, it is necessary to report them immediately to the adverse reaction reporting system of the hospital relying on internet medical treatment.【Expert Recommendation 10】: The attending physician should handle any disputes or complaints about online diagnosis and treatment in accordance with applicable laws, regulations, and guidelines.【Expert Recommendation 11】: Strict confidentiality of patient information must be maintained in online tuberculosis care, and patient consent before data can be used for educational or research purposes.【Expert Recommendation 12】: For primary care facilities that do not have the necessary resources for online diagnosis and treatment, we recommend establishing satellite centers, implementing simplified remote care systems, and utilizing mobile devices in collaboration with nearby hospitals that can provide remote care. This approach aims to increase the capacity of primary care facilities to provide telemedicine service.

РОЛЬ ИММУННОГО ОТВЕТА В РАЗВИТИИ ГИПОКСИЧЕСКИХ ОСЛОЖНЕНИЙ РЕСПИРАТОРНЫХ ИНФЕКЦИЙ НИЖНИХ ДЫХАТЕЛЬНЫХ ПУТЕЙ У ДЕТЕЙ

Pneumonia is one of the most common severe infectious diseases in pediatric practice. Hypoxia is common in children with pneumonia and is one of the main predictors of poor outcome. The role of the central link in the cellular response to hypoxia is played by the family of hypoxia-inducible factors (HIF). HIF-1α is the key regulator of both T- and B-lymphocyte functions. The processes of their maturation are accompanied by the formation of circular DNA fragments, TREC (T-cell Receptor Excision Circle) and KREC (Kappa-deleting Recombination Excision Circle). TREC and KREC are unable to replicate and serve as markers for naive lymphocyte production. In its turn, HIF-1α can be used as a marker for cellular hypoxia. The use of TREC and KREC in assessing the immune system in patients with various immunological and infectious pathologies has already been described. At the same time, HIF-1α has so far been little studied as yet. The purpose of this research was to analyze the scientific bibliographical data on the HIF-1α assessment as a marker for hypoxia as well as the quantitative level of TREC and KREC as markers for the adaptive immune response; to study the bibliographical sources on the effect of hypoxia on the immune response, including as part of lower respiratory tract infections. Methods used: bibliographical research in Scopus, PubMed and Google Scholar with keywords “TREC,” “KREC,” “HIF,” “hypoxia,” “pneumonia,” “immune response,” that was then followed by the search results’ systematization, analysis and synthesis. Results: the analysis of bibliographical sources had allowed the Authors to conclude that there is a possible close connection between acute hypoxia and the formation of an adequate immune response in infectious pathologies. Research in this area is still extremely scarce. At the same time, the prospects for this area determine the need for further fundamental and clinical research. Conclusion: it is of a great scientific and clinical interest to be able to non-invasively assess the degree of acute hypoxia during an ongoing infectious disease by examining urinary HIF-1α levels. Particularly promising is the assessment of the HIF-1α level not only as a regulator of tissue adaptation to acute hypoxia, but also as a modulator of the immune response. Taking into consideration the analyzed data, both TREC and KREC appear to be the optimal markers characterizing the functional state of the adaptive immune system.

Epidemiological and molecular characteristics of Infectious bursal disease virus naturally infected in the broiler flocks in the Mekong Delta of Vietnam during 2015 and 2018

Infectious bursal disease is a highly contagious and economically devastating disease in the poultry industry worldwide caused by Infectious bursal disease virus (IBDV). However, the data on epidemiological and molecular characteristics of the IBDV outbreak in broiler flocks in the Mekong Delta of Vietnam is unclear. Herein, the epidemiological data of IBDV–positive flocks over a period of 2015–2018 were recorded and the hypervariable region of the VP2 gene of IBDV was amplified to analyze the local phylogeny. The current investigation showed that the overall morbidity and mortality rates of IBDV–positive flocks were 45% and 4.81%, respectively. The IBDV–positive birds occurred clinical signs and macroscopic findings involved with the very virulent (vv) IBDV outbreak. Epidemiological results revealed that IBDV was frequently infected in broiler flocks at 12–42 days, and birds belonging to Tau Vang and Binh Dinh breeds were more sensitive to IBDV. Also, the morbidity rate of IBDV was dramatically decreased in the open farming system. Flocks with complete vaccination significantly dropped morbidity in comparison with other groups. Regarding phylogenetic analysis, all identified IBDV sequences clustered in the same branch of vv phenotype and closely homology with prior strains circulated in Vietnam and other countries. These findings first indicated the epidemiological characteristics of the IBDV–positive broiler flocks in the Mekong Delta and highlighted the IBDV strain circulating in this region.

Knockdowns of CD3zeta Chain in Primary NK Cells Illustrate Modulation of Antibody-Dependent Cellular Cytotoxicity Against Human Immunodeficiency Virus-1.

Multifaceted natural killer (NK) cell activities are indispensable for controlling human immunodeficiency virus (HIV)-1 transmission and pathogenesis. Among the diverse functions of NK cells, antibody-dependent cellular cytotoxicity (ADCC) has been shown to predict better HIV-1 protection. ADCC is initiated by the engagement of an Fc γ receptor CD16 with an Fc portion of the antibody, leading to phosphorylation of the CD3 ζ chain (CD3ζ) and Fc receptor γ chain (FcRγ) as well as downstream signaling activation. Though CD3ζ and FcRγ were thought to have overlapping roles in NK cell ADCC, several groups have reported that CD3ζ-mediated signals trigger a more robust ADCC. However, few studies have illustrated the direct contribution of CD3ζ in HIV-1-specific ADCC. To further understand the roles played by CD3ζ in HIV-1-specific ADCC, we developed a CD3ζ knockdown system in primary human NK cells. We observed that HIV-1-specific ADCC was inhibited by CD3ζ perturbation. In summary, we demonstrated that CD3ζ is important for eliciting HIV-1-specific ADCC, and this dynamic can be utilized for NK cell immunotherapeutics against HIV-1 infection and other diseases.

Clinical and pathologic characterization of African swine fever virus infection in pigs in the Mekong Delta, Vietnam

African swine fever (ASF) is a highly infectious disease in pigs caused by the African swine fever virus (ASFV), which might result in 100% mortality. Pigs infected with ASFV might display different clinical and pathological features depending on virulence and host factors. This study aimed to determine features of clinical symptoms, macroscopic, and microscopic lesions of ASF in the Mekong Delta (MD), Vietnam during 2021–2022. The investigation was conducted following three fatal outbreaks of ASF in Hau Giang, Vinh Long, and Can Tho provinces, which are three central provinces out of thirteen in the MD. The spleen, lymph nodes, liver, kidney, and heart were collected from three infected pigs that displayed clinical symptoms of ASFV infection and confirmed the presence of ASFV by conventional PCR. The results indicated that infected pigs showed common clinical symptoms including high fever, anorexia, and moderate petechiae on the skin. Severe hemorrhage was observed in lymph nodes, spleen, kidneys, intestines, and gallbladders which were the main lesions during post-mortem examination. Microscopic lesions were characterized by lymphocytopenia, atrophy of lymphoid follicles in the immune system. However, distinct variations in clinical symptoms, macroscopic, and microscopic features among ASFV infection cases were not documented. This study provides a further understanding of the clinical presentation and pathological lesions caused by the ASFV strain circulating in the MD.

Effects of hydrogen peroxidase-inactivated vaccine against Streptococcus agalactiae infection in red tilapia (Oreochromis sp.) via different routes of administration

Hydrogen peroxidase-inactivated vaccines have recently developed in controlling infectious diseases in aquaculture. The present study aimed to compare the efficacy of the hydrogen peroxidase-inactivated Streptococcus agalactiae vaccine via different delivery routes (injection, immersion, and oral administration) in red tilapia (Oreochromis sp.) without using adjuvant. Fish were randomly divided into 4 groups including G1: Control treatment (without vaccine), G2: vaccine-based diet (oral administration), G3: vaccinated by immersion and G4: vaccinated by injection. After 6 weeks of the experiment, fish were intraperitoneally injected with S. agalactiae and the mortality was recorded in 14 days. The results showed that lysozyme activity was differentially increased according to the delivery routes of vaccine, organs and time of sampling. However, the specific antibody levels in all vaccinated groups were only increased in week 6 post-vaccination. After the challenge test with S. agalactiae, the serum lysozyme levels in G3 and G4 were significantly higher than the control group (G1), while the total white blood cells and specific antibody levels were significantly increased in G2 and G4 compared to the control (G1). Similarly, the hydrogen peroxidase-inactivated vaccine statistically reduced the cumulative mortality in G2 (35.29%) and G4 (28.95%) compared to G1 (44.12%) after injected with the S. agalactiae. These results showed that the vaccine delivery routes by oral administration or injection may decrease the pathogen and show better protection for red tilapia than the immersion method. Further studies will be investigated to improve the efficacy of hydrogen peroxidaseinactivated vaccine via using different adjuvants.

Single monoclonal antibodies should not be used for COVID-19 therapy: a call for antiviral stewardship.

The COVID-19 pandemic saw the largest deployment of monoclonal antibodies (mAbs) for an infectious disease in history. mAbs to SARS-CoV-2 spike protein proved safe and were initially effective for COVID-19 therapy, but each was defeated by continued SARS-CoV-2 evolution, leading to their withdrawal. This was a setback for people with impaired immunity who cannot mount an effective antibody response to SARS-CoV-2 and often cannot clear the virus. New mAbs have now been developed for pre-exposure prophylaxis (PreEP) in immunosuppressed people. Here we argue that while mAb use for PreEP is justified, single mAbs should not be used for COVID-19 therapy. In contrast to PreEP where the viral inoculum is small, immunosuppressed people with COVID-19 have large viral burden that can harbor mAb-escape variants that single-agent mAb treatments can rapidly select for resistance. Selection of mAb-escape variants has potential risks for patients, society and the feasibility of mAb therapy itself.

Infectious Diseases Society of America 2024 Guidance on the Treatment of Antimicrobial-Resistant Gram-Negative Infections.

The Infectious Diseases Society of America (IDSA) is committed to providing up-to-date guidance on the treatment of antimicrobial-resistant (AMR) infections. This guidance document focuses on infections caused by extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E), AmpC β- lactamase-producing Enterobacterales (AmpC-E), carbapenem-resistant Enterobacterales (CRE), Pseudomonas aeruginosa with difficult-to-treat resistance (DTR P. aeruginosa), carbapenem-resistant Acinetobacter baumannii (CRAB), and Stenotrophomonas maltophilia. This updated document replaces previous versions of the guidance document. A panel of six infectious diseases specialists with expertise in managing antimicrobial- resistant infections formulated questions about the treatment of infections caused by ESBL-E, AmpC-E, CRE, DTR P. aeruginosa, CRAB, and S. maltophilia. Because of differences in the epidemiology of AMR and availability of specific anti-infectives internationally, this document focuses on the treatment of AMR infections in the United States. Preferred and alternative suggested treatment approaches are provided with accompanying rationales, assuming the causative organism has been identified and antibiotic susceptibility results are known. Approaches to empiric treatment, transitioning to oral therapy, duration of therapy, and other management considerations are discussed briefly. Suggested approaches apply for both adult and pediatric populations, although suggested antibiotic dosages are provided only for adults. The field of AMR is highly dynamic. Consultation with an infectious diseases specialist is recommended for the treatment of AMR infections. This document is current as of December 31, 2023 and will be updated periodically. The most current version of this document, including date of publication, is available at www.idsociety.org/practice-guideline/amr-guidance/.

Impact of COVID-19 on adverse reactions to subcutaneous specific immunotherapy in children:a retrospective cohort study

BackgroundCOVID-19 is a new infectious disease. To investigate whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection increases the adverse reactions of subcutaneous specific immunotherapy (SCIT) in children.MethodsThis study was conducted by collecting relevant data from children who underwent house dust mite SCIT from April 3, 2021, to March 18, 2023, including information on the time of COVID-19 infection, symptoms, and adverse reactions after each allergen injection. A mixed effects model was used to analyze the changes in adverse reactions before and after the COVID-19 infection.ResultsAmong the records of adverse reactions from 2658 injections in 123 children who underwent SCIT, the overall adverse reaction rate before COVID-19 infection was 39.8% and 30.0% after COVID-19 infection. Compared with pre-infection with COVID-19, the risks of overall adverse reactions, local adverse reactions, and systemic adverse reactions of immunotherapy after COVID-19 infection were reduced (odds ratio [OR] = 0.24, 0.31, and 0.28, all P < 0.05). Among the local adverse reactions, the incidence of the unvaccinated group was the highest (15.3% vs. 7.1%). The incidence of overall and local adverse reactions to SCIT decreased in 2-vaccinated COVID-19 recipients (OR = 0.29–0.31, P < 0.05).ConclusionsIn children, SARS-CoV-2 infection does not increase the incidence of adverse reactions to SCIT. This finding can provide a basis for the implementation of allergen-specific immunotherapy (AIT) during the COVID-19 pandemic.

Identifying and reducing risks of neurological complications associated with vaccination.

Vaccines protect against many infectious diseases, including some that can directly or indirectly cause nervous system damage. Serious neurological consequences of immunization are typically extremely rare, although they have the potential to jeopardize vaccination programmes, as demonstrated most recently during the COVID-19 pandemic. Neurologists have an important role in identifying safety signals at population and individual patient levels, as well as providing advice on the benefit-risk profile of vaccination in cohorts of patients with diverse neurological conditions. This article reviews the links between vaccination and neurological disease and considers how emerging signals can be evaluated and their mechanistic basis identified. We review examples of neurotropic infections with live attenuated vaccines, as well as neuroimmunological and neurovascular sequelae of other types of vaccines. We emphasize that such risks are typically dwarfed by neurological complications associated with natural infection and discuss how the risks can be further mitigated. The COVID-19 pandemic has highlighted the need to rapidly identify and minimize neurological risks of vaccination, and we review the structures that need to be developed to protect public health against these risks in the future.

What are the frequent complaints voiced by inpatients and physicians amidst the emerging infectious diseases? — An illustrative instance of the COVID-19

IntroductionEmerging infectious diseases (EIDs) can disrupt the healthcare system, causing regulatory changes that affect the healthcare-seeking process and potentially increase patient-physician dissatisfaction. This study aimed to collect and analyze patients’ and physicians’ complaints during an EID outbreak to inform potential clues regarding medical quality and patient safety enhancement in future dealing with EIDs, employing text mining methodologies.MethodsIn this descriptive study, complaint records from January 2020 to February 2023 at West China Hospital, a national medical facility in China, were analyzed. Patient and physician complaints have been retrospectively retrieved from the record from the medical department, and then categorized into distinct groups based on reporting reasons, encompassing COVID-19-related policies, healthcare access, availability of medical resources, and financial concerns.ResultsDuring the COVID-19 pandemic, 541 COVID-19-related complaints were identified: 330 (61.00%) from patients and 211 (39.00%) from physicians. The monthly volume of complaints fluctuated, starting at 10 in 2020, peaking at 21 in 2022, and dropping to 14 in 2023. Most complaints from inpatients were expressed by older males aged 40 to 65 (38.82%, 210/541). The primary source of complaints was related to mandatory COVID-19 policies (79.30%, 429/541), followed by concerns regarding timely healthcare services (31.61%, 171/541). Few complaints were expressed regarding the insufficiency of medical resources (2.77%, 15/541) and the high costs (4.25%, 23/541). The frequency of complaints expressed by doctors and patients in the emergency department was higher compared with other departments (24.58%, 133/541).ConclusionsIncreased complaints may serve as a primitive and timely resource for investigating the potential hazards and drawbacks associated with policies pertaining to EIDs. Prompt collection and systematical analysis of patient and physician feedback could help us accurately evaluate the efficacy and repercussions of these policies. Implementing complaints-based assessment might improve care standards in forthcoming healthcare environments grappling with EIDs.

Expert consensus on the construction and improvement of adult vaccination service system at medical institutions

The "Healthy China 2030" plan outlines the goal of providing equitable, accessible, and continuous health services to achieve overall health for the population. However, with the increasing aging population in China, the burden of chronic non-communicable diseases and infectious diseases negatively impacts public health. The elderly population has high hospitalization rates due to infections from influenza virus, respiratory syncytial virus, and streptococcus pneumoniae, which can even lead to death, posing a heavy economic burden on the healthcare system. Meanwhile, the prevalence of chronic diseases and multimobidity among adults are continuously rising, and infections could attack the high-risk groups which cause comlicaitons and severe outcomes. Vaccination is considered the most cost-effective measure for preventing infectious diseases, significantly reducing the disease burden on individuals while effectively controlling the spread of epidemics within the community. Currently, the adult vaccination service system in China is significantly lagging, making it difficult to fully utilize the health protection benefits of vaccines throughout the entire lifecycle. Therefore, to improve adult vaccination services and increase the vaccination rate among high-risk populations for severe diseases, this expert consensus analyzes the current status and challenges of adult vaccination services based on literature reviews and expert discussions. To provide suggestions for the establishment and improvement of adult vaccination service system, and reference health authorities and disease control departments to formulate relevant policies.

Medical perspectives on Israeli children after their release from captivity - A retrospective study.

Following the Hamas terror attack on Israeli towns on October 2023, 250 individuals were taken into captivity. On November-December 2023, during the cease-fire deal, 26 women and children were released. This study is the first to describe the physical and behavioural findings in children and their mothers in the immediate phase of returning home from captivity. This is a retrospective study describing the clinical characteristics of the returnees after 49-53 days in captivity. Patients were admitted to a designated unit in the Schnieder Children's Medical Center of Israel on November-December 2023. The hospitalisation duration was 1-9 days. All patients were evaluated according to a detailed protocol and were treated respectively. Patient population included 19 children (ranged 2-18 years old) and 7 women (ranged 34-78 years old). The most common clinical findings upon return included significant weight loss, psychological trauma, complications of poor hygiene and complications of recent shrapnel injuries. Microbiology tests were positive for multiple gastrointestinal pathogens. Serologic screening tests were positive for various infectious diseases. Clinical findings in this time period were diverse and required the attention of a multidisciplinary team. Long term clinical and psychological effects are yet to be known.

A self-amplifying RNA vaccine prevents enterovirus D68 infection and disease in preclinical models.

The recent emergence and rapid response to severe acute respiratory syndrome coronavirus 2 was enabled by prototype pathogen and vaccine platform approaches, driven by the preemptive application of RNA vaccine technology to the related Middle East respiratory syndrome coronavirus. Recently, the National Institutes of Allergy and Infectious Diseases identified nine virus families of concern, eight enveloped virus families and one nonenveloped virus family, for which vaccine generation is a priority. Although RNA vaccines have been described for a variety of enveloped viruses, a roadmap for their use against nonenveloped viruses is lacking. Enterovirus D68 was recently designated a prototype pathogen within the family Picornaviridae of nonenveloped viruses because of its rapid evolution and respiratory route of transmission, coupled with a lack of diverse anti-enterovirus vaccine approaches in development. Here, we describe a proof-of-concept approach using a clinical stage RNA vaccine platform that induced robust enterovirus D68-neutralizing antibody responses in mice and nonhuman primates and prevented upper and lower respiratory tract infections and neurological disease in mice. In addition, we used our platform to rapidly characterize the antigenic diversity within the six genotypes of enterovirus D68, providing the necessary data to inform multivalent vaccine compositions that can elicit optimal breadth of neutralizing responses. These results demonstrate that RNA vaccines can be used as tools in our pandemic-preparedness toolbox for nonenveloped viruses.

Lithium in the time of COVID: forever vigilant

BackgroundThere have been case reports of renal dysfunction with lithium toxicity among severely ill COVID-19 patients. Lithium levels may be affected by comorbid conditions and the presence of infective disease states like the SARS-CoV-2 which clearly adds systemic health burden. This study aimed to review the effect SARS-CoV-2 has on serum Li levels and the possible mechanism underlying it.MethodsRetrospective data from all clinical service encounters within the University of Michigan health system between September 2019 and September 2023 were reviewed. The study cohort included 98 patients with an average age of 45 years (62% female) who were diagnosed with any subtype of bipolar disorder, actively taking Li, and infected with SARS-CoV-2 during the study timeframe.ResultsThere was no overarching effect of a SARS-CoV-2 infection on Li chemistry in the overall sample. Higher serum Li levels were not significantly associated with SARS-CoV-2 infection nor total comorbidity index. However, higher Li levels were observed in males while infected with SARS-CoV-2 when compared with no infection. eGFR remained unassociated with serum Li level. Receiving COVID vaccination was associated with lower serum Li levels (Coeff. = − 0.88, p = 0.048).ConclusionsPatients with a diagnosis of BD, treated with Li, and infected with SARS-CoV-2 were not likely to present with elevated Li levels unless they are male or unvaccinated. Elevated serum Li level was not associated with significant renal dysfunction in this cohort. The case reports of severe renal complications and Li toxicity may be among cases of greater overall clinical severity of COVID-19. These findings are reassuring that Li may be used in the context of a COVID-19 illness but emphasize the ongoing need for clinical vigilance.

Effects of stress on burnout among infection control nurses during the COVID-19 pandemic: the mediating effects of social support and self-efficacy

BackgroundThis study investigated the mediating effects of self-efficacy and social support on the relationship between stress and burnout among infection control nurses (ICNs) during an emerging infectious disease pandemic.MethodsThe study participants encompassed 210 ICNs with at least six months’ experience in an infection control unit at a general hospital in South Korea during the COVID-19 pandemic. Data were analyzed using independent t-tests or one-way analysis of variance (ANOVA), while descriptive statistics were performed using SPSS/WIN 26.0 software. Hayes’s PROCESS macro 4.2 software was used to verify the significance of the indirect effects of the mediators.ResultsStress had a significant positive effect on burnout (β = 0.80, p < .001), accounting for 73% of the variance. Self-efficacy (β = − 0.26, p < .001) and social support (β = − 0.11, p = .034) had a significant negative effect on burnout, accounting for 78% of the variance. Stress was lower when self-efficacy and social support were entered into the model (β = 0.80 → 0.59), indicating that self-efficacy and social support mediated the relationship between stress and burnout.ConclusionThis study is significant in that it confirms the effects of self-efficacy and social support on the relationship between stress and burnout among ICNs. The results highlight the importance of establishing organizational support systems and developing and implementing programs for enhancing self-efficacy in order to reduce burnout among ICNs.