COVID-19 Pandemic Period Research Articles

Failed/difficult Intubation comparing between pre-COVID-19 and COVID-19 pandemic period using a national insurance claims database and information system of a university hospital

IntroductionEndotracheal intubation can be difficult or even fail under certain patient and anaesthesiologist conditions. During the COVID-19 pandemic a country-wide lockdown policy was enforced in Thailand which stipulated that anaesthesiologists wear personal protective equipment, powered air purifying respirator, or goggles and surgical/N95 mask during the intubation procedure. Thus, an anaesthesiologist’s vision is restricted and grip on the equipment less sure. Under these conditions, the incidence of difficult intubation was expected to increase.MethodsThis time-series study was based on the aggregated age- and sex-standardized monthly incidence of difficult intubation among all intubated patients whose data were recorded in the national insurance claims database and among patients recorded in the records of a university hospital from January 2018 to September 2022. Changes in incidence of difficult intubation following the implementation of a lockdown policy from 26 March 2020 during the COVID-19 pandemic were explored using negative binomial regression and interrupted linear regression time-series analysis.ResultsData of 922,274 individuals in the national database and 95,457 individuals in the university database were retrieved. The overall incidence of difficult intubation in both settings dropped by 25% following lockdown, significantly so in the national database (p < 0.001). At the point of interruption, a significant drop in level was evident in the national data (of 1.682 per thousand per month, P = 0.003) and a non-significant drop at the university level (of 1.118 per thousand per month, P = 0.304).DiscussionThe decreased incidence of difficult intubation during the lockdown period was contrary to expectation but might be related to the deployment solely of anaesthesiologists and more experienced anaesthetic staff using videolaryngoscopes during lockdown following the recommendation for intubation during respiratory disease pandemics.

Unraveling influenza sentinel surveillance in Pakistan 2008-2024: Epidemiological insights during the pre and post pandemic period of COVID-19.

The coronavirus pandemic has substantially influenced the transmission pattern of other respiratory viruses. However, screening and detecting other respiratory pathogens was unheeded during this time to combat the COVID-19 pandemic. High virulence and re assortment factors intensify the importance of influenza virus surveillance for effective disease management. Therefore, the present surveillance study was designed to determine the influenza positivity rate from 2008-24. This study will provide integral support in depicting a panoramic representation of two respiratory-pandemic periods, 2010-11 and 2019-2021, for influenza and COVID-19 pandemics, respectively. An inferential cross-sectional study was conducted from 2008 to 2024 by collecting influenza surveillance data from twelve sentinel sites in Pakistan. Clinical and demographic data was recorded at sample collection time. Specimens were collected through nasopharyngeal/throat swabs and stored in viral transport medium (VTM) at the sentinel site laboratory at 2-4°C. Viral RNA was isolated from the samples using KingFisher TM Flex Purification System and MagMAX™ Viral/Pathogen Nucleic Acid Extraction Kit. Within 16 years, 78118 samples were tested for influenza, of which 7999 (10.2%) appeared positive. The positivity rate appeared very low in recent years, with only a 3.5% positivity rate observed in 2020. Influenza A strain H1N1pdm09 seemed to be the prominent strain (n=3407, 42.6%), followed by influenza B (n=2125, 26.6%). The positivity of influenza samples was 10.2% and recorded in patients where typical clinical representation of influenza was absent. Fewer samples were reported during the coronavirus pandemic, which might be because influenza screening was hindered and overlooked to combat the SARS-CoV-2 virus, and the patient threshold was very high for COVID-19 virus screening.

Impact of speed on injury severity in single-vehicle run-off-road crashes: Insights from partially temporal constrained modeling approach

Single-vehicle run-off-road crashes accounts for approximately 35% of all the traffic fatalities in the U.S during the period of 2019–2021. This paper explores the association between driving speed and injury severity outcomes of single-vehicle run-off-road crashes. The single-vehicle run-off-road crash data from 2019 to 2021 on Interstate freeways in Florida are utilized, and categorized into periods of pre-, during-, and post-COVID-19 pandemic. The partially constrained temporal and temporal unconstrained random parameters logit models are developed considering three injury severity outcomes: no injury, minor injury and serious injury/fatality. Multiple variables in terms of driver, vehicle, roadway, environmental, crash, and temporal attributes are observed to significantly affect the injury severity. Moreover, temporal instability and transferability issues are validated through likelihood ratio test and out-of-sample prediction. In the partially constrained models, numerous variables such as indicators of new vehicle, male driver, and restraint-protected driving consistently yield identical parameter values across all periods, whereas various variables clearly illustrate the distinct differences across the three periods and three speed intervals. The marginal effects in the unconstrained models also display the obvious differences across three periods and three speed intervals. Moreover, the findings corroborate the increased risk outcomes linked to larger speed differences and the COVID-19 pandemic period. These results provide better understanding of the risk mechanisms underlying run-off-road crashes and furnish valuable direction for the formulation of effective safety interventions.

Comparative Analysis of Risk Premium and Stock Market Returns in Indonesia: A Case Study of Normal and COVID-19 Pandemic Periods

This research examines the effect of market risk premium (risk premium) on market returns (JCI). In addition, this study aims to see the effect of premium risk on market returns during the COVID-19 Pandemic. The data used in this study is secondary (JCI data and Deposit Interest Rates) for the period January 2010 – September 2023. The method used in this study is the GARCH method (1.1). The results of this study show a positive and significant influence of risk premium on market returns (JCI). During the COVID-19 Pandemic, risk premiums negatively and significantly affected JCI returns or the Indonesian stock market.

Intrauterine Fetal Death and the COVID-19 Pandemic: Looking beyond SARS- CoV-2 Infection

Background: COVID-19 pandemic has caused high numbers of deaths and complications since 2020. Though the risk is the same as in the general population, pregnant women with COVID-19 are especially susceptible to developing complications because of their altered physiology. The objective of this retrospective study is to investigate the relationship betweenthe COVID-19 pandemic period and intrauterine fetal death, which can help to take steps to reduce intrauterine fetal death during the pandemic. Materials and methods: This retrospective study compared the intrauterine fetal death rate during the pre-pandemic (March 01, 2019 to February 29, 2020) and the pandemic period (March 01, 2020, to February 28, 2021) in a tertiary referral hospital in Bangladesh. Patient data were collected from the record-keeping register of the Department of Obstetrics and Gynecology and analyzed by computer-based software presented in graph, chart and table. Results: Out of 21717 obstetric patients admitted patients,821 (3.78%) were documented as cases of intrauterine fetal death in the pre-pandemic period, whereas in the pandemic period, the number was 895 (4.86%) out of 18424. Due to inadequate data records and considering the exclusion criteria, a total of 790 IUFD patients of the pre-pandemic period and 860 IUFD patients of the pandemic period were included in this study. Conclusion: The percentage of IUFD on obstetric admission showed significantly (p&lt;0.001) higher in the pandemic period compared to that in the pre-pandemic period. This result is important for providing insights to the policy makers for future planning, counseling of women wishing to become pregnant, and prioritizing their safety, including their vaccination. Chatt Maa Shi Hosp Med Coll J; Vol.22 (2); July 2023; Page 47-50

The resilience dynamics of energy ETF accessibility and stock market sentiment in China during the post-pandemic era

This paper investigates the dynamic interaction between energy ETF accessibility and stock market sentiment through the lens of resilience during the post COVID-19 pandemic period. We find that they tend to positively co-move in the long run. Adverse exogenous shocks on one of them not only have a persistent impact on itself but also cause non-diminish damage to the other. Compared to stock market sentiment resilience, energy ETF accessibility resilience is more constrained by the long-run co-movement. The co-movement is not significantly reshaped by possible structural time-breaks or Markovian regime shifts. Further exploration based on wavelet coherence analysis provides evidence for a stable and even gradually strengthening positive coherence between the two types of resilience in a volatile environment. Accordingly, our findings can offer valuable insights for financial regulators to achieve their designed objectives in the secondary markets of energy and stocks.

Linking Meteorological Variables and Particulate Matter PM2.5 in the Aburrá Valley, Colombia

Environmental pollution indicated by the presence of PM2.5 particulate matter varies based on prevailing atmospheric conditions described by certain meteorological variables. Consequently, it is important to understand atmospheric behavior in areas such as the Aburrá Valley, which experiences recurrent pollution events twice a year. This study examines the behavior of specific meteorological variables and PM2.5 particulate matter in the Aburrá Valley. By using statistical analysis tools such as correlation coefficients, principal component analysis (PCA), and multiple linear regression models, the research identifies relationships between PM2.5 and daily cycles of temperature, rainfall, radiation, and wind speed and direction. Datasets were analyzed considering periods before and after the COVID-19 lockdown (pre-pandemic and pandemic, respectively), and specific pollution events were also analyzed. Furthermore, this work considers the relationships between PM2.5 and meteorological variables, contrasting the pre-pandemic and pandemic periods. This study characterizes diurnal cycles of meteorological variables and their relationship with PM2.5. There are consistent patterns among temperature, atmospheric boundary layer (ABL) height, and solar radiation, whereas precipitation and relative humidity show the opposite behavior. PM2.5 exhibits similar relative frequency functions during both daytime and nighttime, regardless of rainfall. An inverse relationship is noted between PM2.5 levels and ABL height at different times of the day. Moreover, the PCA results show that the first principal component explains around 60% of the total variance in the hydrometeorological data. The second PC explains 10%, and the rest of the variance is distributed among the other three to eight PCs. In this sense, there is no significant difference between the two PCAs with hydrometeorological data from a pre-pandemic period and a COVID-19 pandemic period. Multiple regression analysis indicates a significant and consistent dependence of PM2.5 on temperature and solar radiation across both analyzed periods. The application of Generalized Additive Models (GAMs) to our dataset yielded promising results, reflecting the complex relationship between meteorological variables and PM2.5 concentrations. The metrics obtained from the GAM were as follows: Mean Squared Error (MSE) of 98.04, Root Mean Squared Error (RMSE) of 9.90, R-squared (R2) of 0.24, Akaike Information Criterion (AIC) of 110,051.34, and Bayesian Information Criterion (BIC) of 110,140.63. In comparison, the linear regression model exhibited slightly higher MSE (100.49), RMSE (10.02), and lower R-squared (0.22), with AIC and BIC values of 110,407.45 and 110,460.67, respectively. Although the improvement in performance metrics from GAM over the linear model is not conclusive, they indicate a better fit for the complexity of atmospheric dynamics influencing PM2.5 levels. These findings underscore the intricate interplay of meteorological factors and particulate matter concentration, reinforcing the necessity for advanced modeling techniques in environmental studies. This work presents new insights that enhance the diagnosis, understanding, and modeling of environmental pollution, thereby supporting informed decision-making and strengthening management efforts.

Decreased Incidence of Pediatric Neuro-Autoimmune Disorders During COVID-19 Pandemic Restrictions.

Infections are hypothesized to trigger certain autoimmune diseases; however, there is a lack of epidemiologic data surrounding pediatric neuro-autoimmune disorders during the COVID-19 pandemic. Our retrospective study assessed the incidence of pre-defined autoimmune disorders diagnosed at the Children's Hospital of Eastern Ontario in Ottawa, Canada, between October 2017 and June 2024. Inpatient and outpatient charts were queried to identify subjects with neuro-autoimmune disorders or type 1 diabetes as a nonneurologic autoimmune comparison group. Monthly incidences were calculated and compared between 3 COVID-19 pandemic restriction periods: the prerestrictions period (October 2017-March 2020), intrarestrictions period (April 2020-June 2022), and postrestrictions period (July 2022-June 2024). Poisson regression models were fit to the incidence data. New diagnoses of neuro-autoimmune disorders and type 1 diabetes were identified in 111 and 670 subjects, respectively. Incidence of neuro-autoimmune disorders, but not type 1 diabetes, decreased during the intrarestrictions period when compared to the prerestrictions period (incidence rate ratio = 0.57, 95% confidence interval 0.33-0.95, P < .05).

Make Some ‘Noise’ Tonight—Overnight Return as Investor Sentiment Index: Indian Evidence

This research, following Aboody et al., 2018, Journal of Financial and Quantitative Analysis, 53(2), 485–505, and using 612,066 firm-day data daily stock returns, examines whether overnight return is a reliable proxy for firm-specific investor sentiment in India. The study also probes into the impact of the COVID-19 crisis on the relevance of overnight returns for Indian stock investors. The time series approach pursued in the study provides evidence of short-term overnight-return persistence, where the impact is more on the firms with complex valuation and arbitrage structures. Moreover, short-term overnight-return persistence is higher during the COVID-19 pandemic period, highlighting its significance as an indicator of firm-specific investor sentiment in the face of market volatility. In contrast to earlier results of transient sentiment-driven mispricing, we demonstrate that overnight returns in India do not reverse over time. We found that even during the height of the epidemic, overnight returns were only partially indicative of firm-specific investor sentiment in emerging markets such as India.

The dynamics of digitalisation of ultra-micro, micro, small, and medium enterprises during COVID-19 pandemic and recovery periods: evidence from Indonesia

ABSTRACT This study investigates the causal impact of the COVID-19 pandemic on digitalisation adoption among Indonesia’s ultra-micro, micro, small and medium enterprises (UMSMEs) during the pandemic and recovery periods. Using data from Bank Indonesia’s UMSMEs Development Survey 2019–2022, we employ the Callaway and Sant’Anna difference-in-differences (CSDID) method. The findings indicate that, in general, there was an increase in digitalisation adoption by enterprises during both pandemic and recovery periods. Furthermore, we uncover the significant impact of COVID-19 on increasing the overall digitalisation adoption by enterprises during both periods. However, there are variations across different digitalisation channels and enterprise scales. The findings suggest that enterprises are rational in their digitalisation adoption. The implications of this study point to the importance of fostering a digitalisation ecosystem that offers a diverse array of affordable options for digital channels, allowing enterprises to select options that best suit their needs.

CHALLENGES IN BRAIN METASTASES DIAGNOSIS AND TREATMENT

Although brain metastases are the most frequent type of intracranial tumors, their diagnosis and treatment is still challenging. They have poor prognosis and life expectancy is short, as brain metastases appear in advanced stage cancers. In U.S., the rate of recently discovered cancer that will evolve with brain metastases is considered to be 6-14%. Left untreated, brain metastases become lethal in less than 2 months. The most common primary cancers that develop brain metastases are lung, breast, melanoma and colorectal. In our department, approximately 60 patients with brain tumors were diagnosed after surgery with brain metastases in the last 10 years. The most common cancer to metastasize by far was lung cancer, with a mean age at diagnosis 60 years old, affecting mostly smoking men. The majority of patients presented with multiple metastases, unaware of the primary disease and without conducting any oncological treatment prior to admission in our departement. We observed that COVID-19 pandemic period highly affected patients with cancer. The number of patients with brain metastases operated on in our department has drastically decreased in that period. There were a lot of reasons why cancer patients among which being the imposibility to reach emergency rooms without having COVID-19 symptoms and difficulty of reaching radiology centers for early imaging. Most of the patients presented in the Emergency Department with multiple brain metastases, comatose or with focal neurological deficits installed long before presentation, regardless of their primary cancer, thus making neurosurgery an impractical option for most of these cases. Although there have been significant advances in systemic oncological treatment and radiotherapy, surgery remains an essential method of managing brain metastases, even in cases presenting with multiple lesions. Careful patient selection is essential in obtaining the best outcome.

What is the state of play? A nursing and midwifery workplace satisfaction survey across five local health districts

Background The COVID-19 pandemic and recovery period have exacerbated workforce challenges for nurses and midwives. The increasingly complex nature of healthcare, combined with rising workloads and staff attrition highlights the need for initiatives that improve workplace satisfaction and retention. In response, mentoring programs aimed at enhancing job satisfaction and retention are being increasingly implemented. Aims This study sought to measure the workplace satisfaction of nurses and midwives across five New South Wales local health districts, utilising data captured from a wider study investigating the implementation of the Deadly Aboriginal and Torres Strait Islander Nursing and Midwifery Mentoring program. Design An exploratory, mixed methods study using purposive sampling was employed. Methods A secondary analysis of a modified version of the Nursing Workplace Satisfaction Questionnaire, was used to quantify intrinsic, extrinsic, and relational workplace satisfaction constructs among nursing and midwifery staff. Open ended questions included in the survey were thematically analysed using methods developed by Braun and Clarke (2022). Results Between June–October 2023, n = 106 participants returned the survey. Differences between intrinsic (items 2 & 5), extrinsic (item 9) relational (items 13-15) constructs were observed for health districts, Aboriginality, age, and professional role characteristics (P < 0.05). Five qualitative themes emerged from the data: Helping people is the priority; Teams make a difference to my workplace satisfaction; Managers impact my satisfaction; Scope and recognition; and Organisational factors. Conclusions Overall, our findings indicate noticeable differences in workforce satisfaction and retention across various factors, including workforce areas, Aboriginality, age, and professional roles. For these groups, initiatives aimed at improving satisfaction and retention should prioritise fostering teamwork and a sense of belonging, as these elements have significant impact on job satisfaction for nurses and midwives and provide valuable guidance for nursing leaders. Impact statement This study identifies that teamwork and belongingness impact workplace satisfaction for nurses and midwives.

COVID-19 and pregnancy: a comprehensive study of comorbidities and outcomes

ObjectivesThis study aimed to investigate the impact of pregnancy and pre-existing comorbidities on COVID-19 infections and associated complications of hospitalisation and mortality in women of reproductive age (WRA). The study also compared the risk of severe COVID-19 complications between pregnant women (PW) and non-pregnant women (NPW) with and without pre-existing comorbidities. Special focus was placed on some understudied comorbidities of immunosuppression, chronic renal disease and chronic obstructive pulmonary disease (COPD).MethodsThe study utilized anonymized patient-related information for a population of 7,342,869 WRA from the Mexican Ministry of Health data repository on COVID-19. Descriptive variables were characterized using frequencies, percentages, means, and standard deviations. Adjusted odds ratios (aORs) were used to assess the associations between risk factors and outcomes of hospitalisation and mortality. The study covered the entire COVID-19 pandemic period from January 30, 2020, to May 5, 2023.ResultsThe findings revealed that PW were not more likely to get COVID-19 infections than NPW. PW with COVID-19 infections were more likely to require hospital admission, intubation treatments, and ICU admission compared to NPW with COVID-19. PW with immunosuppression had an increased odds ratio (aOR) of getting COVID-19 infections compared to NPW (PW: aOR = 1.0396; NPW: aOR = 0.8373). NPW with immunosuppression had higher risk of mortality (all-cause death: aOR = 1.7084; COVID-19-associated death: aOR = 1.4079) and hospitalisation (all-cause hospitalisation: aOR = 4.1328; COVID-19-associated hospitalisation: aOR = 3.0451) than NPW without immunosuppression. Renal disease was identified as a concerning pre-existing condition that increased the risks of COVID-19 associated mortality/hospitalizations and all-cause mortality/hospitalizations for both PW and NPW. NPW with renal disease had much higher odds ratio (aOR) of either COVID-19-associated-hospitalisations (NPW: aOR = 8.639; PW: aOR = 1.7603) or all-cause hospitalisations (NPW: aOR = 8.8594; PW: aOR = 1.786) than PW with renal disease.ConclusionsThis study provides valuable insights into the impact of pregnancy and pre-existing comorbidities on COVID-19 outcomes in WRA. The findings underscore the importance of considering demographic factors and pre-existing comorbidities in the management of PW with COVID-19. The study also highlights the need for further research to understand the unique impacts of different comorbidities, particularly immunosuppression and renal disease, on COVID-19 outcomes in WRA.

HPB SO66 - Has the Complexity of Laparoscopic Cholecystectomies Increased Following the COVID-19 Pandemic?

Abstract Background Laparoscopic cholecystectomy (LC) is recognized for its diverse complexity between cases, which profoundly influences perioperative progression and patient outcomes. It is notoriously difficult to accurately predict surgical complexity pre-operatively. The COVID-19 pandemic notably contributed to substantial delays in the definitive management of gallstone disease. The present study aimed to compare the intraoperative complexity grading of LCs performed post-pandemic with data previously reported in the literature. Method A prospectively collected database of all LCs and laparoscopic common bile duct exploration (LCBDE) performed between August 2022 and June 2024 was analysed. The database was populated from a single benign biliary center by two specialized biliary surgeons. The study focused on clinical and intraoperative parameters, with particular emphasis on assessing the cholecystectomy operative difficulty using the Nassar scale. Parameters from the database were compared with previously published data from a single surgeon over a 29-year period (n=5,391 cases). P value was calculated using Pearson uncorrected chi-square test. Results 201 patients were eligible for inclusion. Median age was 54 years (IQR 40-66) and 124 (61.7%) were female. 86 (42.8%) were emergency cases. 118 (58.7%) patients were classed as socially and economically deprived. 80 (39.8%) cases were carried out for acute cholecystitis and 48 (23.9%) were for gallstone pancreatitis. 52 (25.8%) underwent LC alone, 89 (44.3%) also had intra-operative cholangiogram and 60 (29.9%) underwent LCBDE. Grade-1 LC (33.2% vs 8%, p&amp;lt;0.001) were significantly less prevalent than grade-4 LC (14.2% vs 33.8%, p&amp;lt;0.001) in the post pandemic period when compared to the previous published data. Conclusion The present study suggests there has been an increase in the complexity and operative difficulty of LC in the immediate post COVID-19 pandemic period. The reasons are likely multifactorial, however delays in the timely management of gallstone disease, resulting in repeated episodes of acute inflammation is hypothesised to be the key driving factor. Minimising a delay to definitive treatment through the establishment of efficient dedicated biliary care pathways could reduce the incidence of complex LC. Further work is required to determine if reducing the incidence of complex LC has a beneficial impact on complications and length of hospital stay.

Banking Financial Performance as Influenced by Credit Risk, Liquidity and Bank Size In Conventional Banks Listed On The Indonesian Stock Exchange For The Period 2014 - 2023

This study aims to empirically examine the impact of credit risk, liquidity, and bank size on the financial performance of conventional banks listed on the Indonesia Stock Exchange (IDX) during the period 2014-2023, with a particular focus on the COVID-19 pandemic period. The research variables used include the Non-Performing Loan (NPL) ratio, Loan to Deposit Ratio (LDR), and bank size, while Return on Assets (ROA) is used as a financial performance indicator. This study uses the purposive sampling method to select a sample from 138 banks listed on the IDX, resulting in 9 banks that meet the established criteria. Data analysis was conducted using panel data regression with the Fixed Effect Generalized Least Square (GLS) model to address the issues of autocorrelation and heteroskedasticity found in classical assumptions. The research results show that credit risk (NPL) has a significant negative impact on ROA, while bank size and liquidity (LDR) have a significant positive impact on ROA during the pandemic. These findings highlight the importance of managing credit and liquidity risks as well as optimizing bank size to improve financial performance amid the challenging economic conditions caused by the pandemic. This study also suggests that the financial performance of banks can be more stable if supported by appropriate risk management strategies and good operational efficiency. The limitations of this study include a sample restricted to conventional banks in Indonesia and the specific conditions during the COVID-19 pandemic, which may affect the generalization of the results.

A RESPONSABILIZAÇÃO DOS AGENTES PÚBLICOS POR FRAUDES NAS AQUISIÇÕES PÚBLICAS DURANTE A PANDEMIA DE COVID-19

This is a scientific production whose theme is the accountability of public agents for fraud in public procurement during the COVID-19 pandemic. The Law of Administrative Improbity has been standing out in several aspects of the legal system and evolving in terms of legal and current protection, giving concreteness to the constitutional demand of art. 37, § 4.º, in order to effectively protect administrative morality, valuing honesty in dealing with public matters. For this, penalties have been sanctioned when there is disrespect for probity. This work was dedicated to analyzing the cases of accountability of public agents for fraud in acquisitions during the pandemic period of COVID-19, making an analysis of the concepts brought by the doctrinators and characterizing the improbable conduct, based on the principles of the Federal Constitution of 1988 and especially in compliance with Law No. 14230/21, which provides for administrative impropriety. The methodology used was a descriptive and exploratory literature review, with a qualitative approach. Regarding the results obtained, it is correct to state that during the pandemic period, mainly between the years 2020 and 2021, several public agents were involved in embezzlement, as shown in cases I, II, III and IV. As a result, there is passive corruption, which is practiced by the public agent who requests or receives, for himself or for another person of his interest, either directly or indirectly, any undue advantage due to the position he occupies.

The Prevalence, Serogroup Distribution and Risk Factors of Meningococcal Carriage in Children, Adolescents and Young Adults in Turkey Meningo-Carr-TR Study PART 3: COVID-19 Pandemic Situation

Background: The prevalence of meningococcal carriage and serogroup distribution is crucial for assessing the epidemiology of invasive meningococcal disease, forecasting outbreaks and formulating potential immunization strategies. Following the meningococcal carriage studies conducted in Turkey in 2016 and 2018, we planned to re-evaluate meningococcal carriage in children, adolescents and young adults during the COVID-19 pandemic period. Methods: In the MENINGO-CARR-3 study, we collected nasopharyngeal samples from 1585 participants 0–24 years of age, across 9 different centers in Turkey. We used polymerase chain reaction and serogroup distribution to determine how common it is for people to carry Neisseria meningitidis. Results: The overall meningococcal carriage rate was 8.5% (n = 134). The serogroup distribution was as follows: serogroup A, 6%; serogroup B, 30.6%; serogroup W, 12.7%; serogroup Y, 3.7%; serogroup X, 1.5% and nongroupable as 45.5%. The highest carriage rate was found in 15–17-year-old adolescents (24.1%, 17.9%, and 20.2%, respectively). The carriage rate was higher among participants who had a previous COVID-19 infection (P = 0.05; odds ratio: 1.95; 95% confidence interval: 1.11–3.44). The nasopharyngeal carriage rate was also higher than in the 2016 and 2018 studies (8.45% vs. 6.3% and 7.5%, respectively), and the most prevalent groupable serogroup was B during this study period, followed by serogroup W in 2016 and serogroup X in 2018. Conclusions: The present study found that meningococcal carriage was higher during the post-COVID-19 pandemic period, especially in adolescents and young adults. Severe acute respiratory syndrome coronavirus-2 virus itself and/or pandemic mitigation strategies may affect both meningococcal carriage and serogroup distribution. Serogroup distribution varies between years, and further immunization strategies, including adolescent immunization, may play a role in controlling invasive meningococcal disease.

Prospective clinical surveillance for severe acute respiratory illness and COVID-19 vaccine effectiveness in Kenyan hospitals during the COVID-19 pandemic.

There are limited data from sub-Saharan Africa describing the demographic characteristics, clinical features and outcome of patients admitted to public hospitals with severe acute respiratory infections during the COVID-19 pandemic. We conducted a prospective longitudinal hospital-based sentinel surveillance between May 2020 and December 2022 at 16 public hospitals in Kenya. All patients aged above 18 years admitted to adult medical wards in the participating hospitals were included. We collected data on demographic and clinical characteristics, SARS-CoV-2 infection and COVID-19 vaccination status and, admission episode outcomes. We determined COVID-19 vaccine effectiveness (VE) against admission with SARS-CoV-2 positive severe acute respiratory illness (SARI) (i.e., COVID-19) andprogression to inpatient mortality among patients admitted with SARI, using a test-negative case control design. Of the 52,636 patients included in the study, 17,950 (34.1%) were admitted with SARI. The median age was 50 years. Patients were equally distributed across sexes. Pneumonia was the most common diagnosis at discharge. Hypertension, Human Immunodeficiency Virus (HIV) infection and Diabetes Mellitus were the most common chronic comorbidities. SARS-CoV-2 test results were positive in 2,364 (27.9%) of the 8,471 patients that underwent testing. After adjusting for age, sex and presence of a chronic comorbidity, SARI patients were more likely to progress to inpatient mortality compared to non-SARI patients regardless of their SARS-CoV-2 infection status (adjusted odds ratio (aOR) for SARI and SARS-CoV-2 negative patients 1.22, 95% CI 1.10-1.37; and aOR for SARI and SARS-CoV-2 positive patients 1.32, 95% CI 1.24-1.40). After adjusting for age, sex and presence of a chronic comorbidity, COVID-19 VE against progression to inpatient mortality following admission with SARI for those with a confirmed vaccination status was 0.59 (95% CI 0.27-0.77). We have provided a comprehensive description of the demographic and clinical pattern of admissions with SARI in Kenyan hospitals during the COVID-19 pandemic period as well as the COVID-19 VE for these patients. These data were useful in providing situational awareness during the first three years of the pandemic in Kenya and informing national response measures.

The early COVID-19 pandemic period and associated gestational weight gain.

The aim of this study was to investigate if gestational weight gain was altered during the early COVID-19 pandemic period. This a retrospective cohort study evaluating gestational weight gain among individuals delivering during the early COVID-19 pandemic epoch (March 10-December 31,2020) compared to temporally matched pre-pandemic (matched months in 2018 and 2019) controls using electronic medical record data from a large tertiary care hospital. The primary outcome was gestational weight gain defined as a categorical measure representing below, meeting, or above Institute of Medicine (IOM) criteria with further adjustment for gestational age at delivery. The early-pandemic exposure group was also categorized by gestational age at the start period (<14weeks' and 14-20weeks') to assess if duration of exposure affected gestational weight gain risks with the use of multinominal logistic regression. Among 5,377 individuals 3,619 (67.3 %) and 1,758 (32.7 %) were in the pre and early pandemic epochs respectively. Overall, 934 (17.4 %) individuals gained below recommended, 1,280 (23.8 %) met recommendations, and 3,163 (58.8 %) gained above IOM recommended gestational weight gain. Compared to the pre-pandemic epoch, the early pandemic period was not associated with weight gain below (OR 1.06, 95 % Cl 0.89-1.27) or above (OR 1.03, 95 % Cl 0.89-1.19) IOM recommendations. This was also true when the early pandemic group was stratified based on gestational age at the start of the early pandemic period (<14weeks' and 14-20weeks'). This study demonstrated no significant difference in maternal weight gain between pre and early COVID-19 pandemic periods.

Association Between Short-Term Exposure to Air Pollutants and Emergency Attendance for Upper Gastrointestinal Bleeding in Hong Kong: A Time-Series Study.

The relationship between exposure to ambient air pollutants and emergency attendance for upper gastrointestinal bleeding (UGIB) remains inconclusive. This study examines the association between short-term exposure to various ambient pollutants and the risk of UGIB emergency attendance. Data on daily UGIB emergency attendance, ambient pollutants, and meteorological conditions in Hong Kong were collected from 2017 to 2022. A time-series study using a distributed lag non-linear model to analyze the data, considering lag days. Stratified analysis was performed based on sex, seasons, and the COVID-19 pandemic period. The burden was quantified using attributable fraction (AF) and number (AN). The study included 31,577 UGIB emergency records. Exposure to high levels of PM2.5 significantly increased the risk of UGIB emergency attendance from lag day 3 (RR: 1.012) to day 6 (RR: 1.008). High NO2 exposure also posed a significant risk from lag day 0 (RR: 1.026) to day 2 (RR: 1.014), and from lag day 5 (RR: 1.013) to day 7 (RR: 1.024). However, there was no association between UGIB and high O3 levels. The attributable burden of high-concentration NO2 exposure was higher compared to those of PM2.5. Males and elderly individuals (≥65years) faced a higher risk of UGIB emergencies, particularly during cold seasons. Our study suggests that both PM2.5 and NO2 exposure are associated with an increased risk of emergency attendance for UGIB. Ambient pollutant exposure has a stronger effect on UGIB in males and the elderly, particularly during cold seasons.